Comprehensive Evaluation Of Recurrent Laryngeal Nerve Anastomosis In The Treatment Of Thyroid Carcinoma Invading Recurrent Laryngeal Nerve

Objectives:To investigate the comprehensive effect of recurrent laryngeal nerve anastomosis in the treatment of thyroid carcinoma invading recurrent laryngeal nerve,and to provide reference for clinical work.Methods:From January 2012 to January 2020,21 patients with differentiated thyroid cancer involving recurrent laryngeal nerve who were admitted to the Department of Otolaryngology,Head and Neck of our hospital and needed unilateral neurotomy were treated with recurrent laryngeal nerve anastomosis(anastomosis group)at the same time.A total of 26 matched thyroid cancer patients who underwent unilateral neurotomy due to thyroid cancer invasion in our hospital during the same period were selected as control group(resection group).Six months after surgery,the patients underwent electronic laryngoscopy,objective assessment of laryngeal function,subjective feedback and subjective assessment of voice impairment index(VHI),and were followed up by telephone for recurrence and survival.The objective evaluation indexes of laryngeal function included Jitter,Shimmer and MPT(longest pronunciation time),while the subjective evaluation of Voice Disorder Index(VHI)included physiological,functional and emotional categories,and the scores of the three aspects and the total score were recorded.Resukts:Under electronic laryngoscopy,21 patients in anastomotic group had normal vocal cord shape,good tension,complete or almost complete closure of glottis,and normal mucosal wave in affected side without obvious vocal cord activity.In the resection group of 26 patients,all the affected vocal cords were fixed under electronic laryngoscopy,23 of the affected vocal cords were relaxed without tension,and the edges were curved.The glottis closed and left suture in the vocal position,and the mucosal wave was fibrillation.3 patient’s vocal cords were close to normal and mucosal wave was close to normal,almost complete closure of glottis in the vocal position.In objective vocal parameters,MPT and Jitter in the anastomotic group were better than those in the excision group,with statistical significance(P<0.05).There was no statistically significant difference between the Shimmer anastomosis group and the resection group(P=0.205),but the Shimmer indexes in the anastomosis group tended to be normal(Shimmer normal<3%).Subjective feedback of hoarseness in anastomosis group all returned to preoperative normal level or basically normal;In the resection group,23 cases of hoarseness did not recover and 3 cases recovered slightly.In the subjective evaluation of VHI,the anastomosis group was superior to the resection group in terms of total score,physiology,function and emotion,and the difference was statistically significant(P<0.05).Among the patients who underwent recurrent laryngeal nerve resection and neuroanastomosis at the same time,2 patients developed lymph node metastasis,and no recurrence occurred after surgical treatment.There were 2 cases of lymph node metastasis in the patients who underwent recurrent laryngeal nerve resection,and no recurrence was found after surgical treatment.All the patients were tumor-free.Conclusions:The loss of recurrent laryngeal nerve function has a comprehensive impact on patients.The voice dysfunction reduces the quality of life of patients and affects their physical and mental health.Although recurrent laryngeal nerve anastomosis can not restore the movement of vocal cords,it can improve the voice function of patients and improve the quality of life of patients.It is suggested that the recurrent laryngeal nerve anastomosis should be performed at the same time when the recurrent laryngeal nerve is involved in differentiated thyroid carcinoma and requires unilateral neurotomy..