甲状腺手术区解剖的外科应用  

Applied Anatomy of Region of Thyroid Operation in Surgery

作　　者：伍绍思[1] 蒋竟杭[1] 李培[1] 唐勇[1] 刘国平[1] 

机构地区：[1]湖南省永州职业技术学院医学院

出　　处：《中国现代手术学杂志》2005年第4期278-280,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的寻求甲状腺手术中对喉上神经和喉返神经提供定位和保护的应用解剖标志。方法解剖100具(200侧)颈部尸体标本,在甲状腺手术区对喉上神经和喉返神经及其分支进行定位观测。结果①喉上神经在咽上缩肌外面分为两支内支与喉上动脉伴行穿甲状舌骨膜入喉;外支伴随甲状腺上动脉后内方下行。②右喉返神经在甲状腺下动脉之前、之后、在动脉分支之间以及神经与血管相互夹持穿过者分别为48条(48%)、24条(24%)、14条(14%)、14条(14%),左喉返神经则分别为15条(15%)、57条(57%)、15条(15%)及13条(13%)。③117条(58.5%)喉返神经在甲状腺下极平面以上平均(9.9±7.3)mm,19条(9.5%)在甲状腺下极平面,64条(32%)在其平面以下平均(8.5±5.6)mm。④喉返神经前支入喉处距甲状软骨下角尖端平均(7.4±3.7)mm,其中72侧(36%)在其前平均(1.6±0.8)mm,58侧(29%)在其后平均(1.8±0.5)mm,70侧(35%)在其正下方入喉。后支入喉处距甲状软骨下角尖端平均(7.3±3.2)mm,16侧(8%)在其前平均(1.7±0.9)mm,134侧(67%)在其后平均(1.8±1.2)mm,50侧(25%)在其正下方入喉。结论在甲状腺手术中,结扎甲状腺上动脉要紧靠甲状腺侧叶上极;结扎甲状腺下动脉需仔细分离、单独结扎,以免损伤喉返神经或其分支而发生并发症。Objective To introduce anatomic landmark for location and protection of superior laryngeal nerve and recurrent laryngeal nerve in thyroid surgery. Methods Peri-thyroid region were dissected in 100 cadaver cervical part with regard to location observation of trunks and branches of superior laryngeal nerve and recurrent laryngeal nerve. Results ① Superior laryngeal nerve gave off two branches on the outer side of superior constrictor of pharynx, the internal branches pierced the thyroid membrane into laryngeal in company with the superior laryngeal artery, the external branches descended along with superior thyroid artery posterointeriorly. ② Right recurrent laryngeal nerve ran anterior to inferior thyroid artery, posterior to inferior thyroid artery, between the arterial branches and climbing along the artery were observed in 48（48% ） ,24（ 24% ）, 14（ 14% ） and 14（ 14% ）cases respectively, whereas the left recurrent laryngeal nerve were observed in 15 （15%） ,57（57% ）, 15（ 15% ）and 13（ 13% ） cases respectively. ③ The recurrent laryngeal nerve cross the thyroid in 19 branches （9.5%） at the very level of the low pole of thyroid, in 117 branches （58.5%） at the level of （9.9 ± 7.3 ）mm superiorly, and in 64 branches （32%） at the level of （8.5 ± 5.6） mm inferiorly. ④ The anterior branch of recurrent laryngeal nerve pierced into larynx distantly （7.4 ± 3.7） mm from cornu inferior cartilaginous thyroidean, including （ 1.6 ± 0.8 ） mm anteriorly in 72 sides （ 36% ）, （ 1.8 ± 0.5 ） mm posteriorly in 58 sides （ 29% ）, right inferiorly in 70 sides （35%）. The posterior branch of recurrent laryngeal nerve pierced into larynx distantly （7.3 ± 3.2） mm from cornu inferius cartilaginis thyroideae, including（ 1.7 ±0. 9）mm anteriorly in 16 sides （8%）, （ 1.8 ± 1.2） mm posteriorly in 134 sides （67%）, right inferiorly in 50 sides （25%）. Conclusion The superior thyroid artery must be ligated near the upper pole of thyroid, wher

关 键 词：喉上神经 喉返神经 甲状腺切除术 

分 类 号：R653[医药卫生—外科学]