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Intraoperative Vermeidung und Erkennung von Rekurrensparesen in der Schilddrüsenchirurgie

Intraoperative avoidance and recognition of recurrent laryngeal nerve palsy in thyroid surgery

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Zusammenfassung

Die Rekurrensparese ist eine wesentliche Komplikation in der Schilddrüsenchirurgie. Die Vermeidung der Rekurrensparese gilt als ein Qualitätsmerkmal dieser sehr häufigen Operation. Es werden Risikofaktoren und Vermeidungsstrategien dargelegt und anhand der aktuellen Literatur erörtert. Die exakten anatomischen Kenntnisse mit den möglichen Varianten des Nervenverlaufs sowie die visuelle Darstellung und sorgfältige Präparation des Rekurrensnerven sind der Grundstein für die Nervenschonung. Der Einsatz des Neuromonitorings ermöglicht die Sicherung der anatomischen Struktur und der funktionellen Integrität des Nerven und kann Schäden detektieren, die rein visuell nicht erkennbar sind. Voraussetzung für die korrekte Interpretation sind eine standardisierte Anwendung und die prä- und postoperative Laryngoskopie.

Abstract

Recurrent laryngeal nerve palsy is an intrinsic complication of thyroid surgery. Prevention of nerve palsy is considered to be a feature of quality in this very frequently performed operation. Risk factors and prevention strategies are demonstrated and discussed with reference to the current literature. Exact knowledge of the anatomy and possible variants of the track of the recurrent laryngeal nerve as well as its visualization and careful dissection are the cornerstones for nerve preservation. The use of intraoperative neuromonitoring allows preservation of the anatomical structure and functional integrity of the nerve and lesions which are not visible can be detected. Preconditions for correct interpretation are a standardized application and preoperative and postoperative laryngoscopy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Simon, M. Boucher und P. Schmidt-Wilcke geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klink für Allgemein- und Viszeralchirurgie, Thoraxchirurgie und Endokrine Chirurgie, Ev. Krankenhaus Bethesda Duisburg GmbH, Heerstr. 219, 47053, Duisburg, Deutschland

    D. Simon, M. Boucher & P. Schmidt-Wilcke

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  1. D. Simon
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  2. M. Boucher
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  3. P. Schmidt-Wilcke
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Correspondence to D. Simon.

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Simon, D., Boucher, M. & Schmidt-Wilcke, P. Intraoperative Vermeidung und Erkennung von Rekurrensparesen in der Schilddrüsenchirurgie. Chirurg 86, 6–12 (2015). https://doi.org/10.1007/s00104-014-2816-9

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