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| Clinical characteristics and prediction strategy of non-recurrent laryngeal nerve related to thyroid surgery |
| LI Peixin1 QIN Shengqi1 WANG Jin1 ZHAO Ning2 GE Zhicheng2 TENG Changsheng2 ZHANG Zhongtao2 QU Xiang2 |
1.Department of Comprehensive Surgery, Medical and Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;
2.Branch Center, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Abstract Objective To investigate the clinical characteristics and prediction strategy of non-recurrent laryngeal nerve (NRLN) related to thyroid surgery. Methods The clinical data of 175 patients who underwent thyroid surgery for benign and malignant thyroid tumors from August 2009 to February 2022 in Department of Comprehensive Surgery, Medical and Health Center, Beijing Friendship Hospital (hereinafter referred to as “our department”) were retrospectively analyzed; in addition, only enroll Chinese patients as study objectives in CNKI, Wanfang, PubMed, and Web of Science database were retrieved by using “non-recurrent laryngeal nerve”,“non recurrent laryngeal nerve”, “non-recurrent inferior laryngeal nerve”, “recurrent laryngeal nerve”, “inferior laryngeal nerve”, “NRLN”, and “NRILN” as search terms, the search period was from January 2012 to February 2022. The total incidence, the incidence of right side, Stewart classification, injury rate of NRLN, and the results of NRLN predicted by preoperative imaging were counted. Results One right NRLN, Stewart type Ⅰ, was found in our department. The total incidence of NRLN was 0.32%, and the incidence of right NRLN was 0.63%, and there was no intraoperative injury in all cases. Meta-analysis showed that the total incidence of NRLN was 0.46% (95%CI: 0.26%-0.66%); the incidence of right side was 0.45% (95%CI: 0.22%-0.68%); the incidence of Stewart type Ⅰ was 76.47% (95%CI: 58.61%-94.33%), and type Ⅱ was 23.53% (95%CI: 5.67%-41.39%); the injury rate was 10.20% (95%CI: 2.93%-17.47%). Imaging prediction showed the presence of an anomalous right subclavian artery in 90% (81/90); the rate of missed diagnosis of NRLN predicted by CT was 19.23%, the misdiagnosis rate of NRLN predicted by chest X-ray was 56.67%, the rate of missed diagnosis of NRLN predicted by ultrasound was 7.25%. Conclusion NRLN is a rare variation with high risk of intraoperative injury, and can be predicted preoperatively by imaging examination, CT and ultrasound scan demonstrate high accuracy.
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