甲状腺手术中喉返神经变异的临床研究  

Variation of recurrent laryngeal nerve found in thyroid surgery

作　　者：张品一[1] 张滨[1] 刘垚[1] 张伟峰[1] 

机构地区：[1]哈尔滨医科大学附属第二医院普外四科,150086

出　　处：《中华普通外科杂志》2013年第6期431-435,共5页Chinese Journal of General Surgery

摘　　要：目的总结甲状腺手术中发现的喉返神经解剖变异的特点，并探讨各种变异类型的识别与保护要点。方法回顾性分析2010年6月至2012年6月1548例常规显露喉返神经的甲状腺手术患者的临床资料，总结术中喉返神经的变异类型、变异率及解剖特点，分析神经的损伤情况。结果1548例患者手术中显露喉返神经共2620根，其中全程解剖1886根，损伤11根（0．42％）。全组2620根喉返神经中，发生条件变异共64根。1886根全程解剖的喉返神经中，存在自然变异共421根（22．3％），包括分支形态变异126根（6．68％），走行位置变异124根（6．57％），甲状腺下动脉处变异36根（1．91％），Berry韧带处变异112根（5．94％），环甲关节处变异17根（0．80％），非返型变异6根（0．32％）。结论甲状腺手术中所见喉返神经的变异复杂多样、变异率较高，其导致术中对神经的错误识别是造成神经损伤的重要潜在因素；全面掌握正常与各种变异的解剖特点是甲状腺手术中成功显露并保护喉返神经的关键。Objective To summarize the anatomic variations of recurrent laryngeal nerve （RLN） during thyroid surgery and to investigate the technical key points for identification and preservation of the nerve. Methods Clinical data of 1548 consecutive patients undergoing thyroid operation with intraoperative routine exposure of RLN from June 2010 to June 2012 was retrospectively analyzed. Results In this series, 2620 RLNs at risk were clearly exposed and identified during a total of 1548 thyroid operations, wherein complete dissection was performed on 1886 nerves. Injury occurred in 11 of 2620（0.42% ）nerves. Through the analysis of all 2620 RLNs, conditional variations were found in 64 nerves. Of 1886 RLNs that were completely dissected, 421 （22. 3% ）nerves presented with natural variations of six patterns, including morphological branching variation in 126 （ 6. 68% ） nerves, course and location variation in 124 （ 6. 57% ） nerves, variation in relationship with inferior thyroid artery （ITA） in 36 （ 1.91% ） nerves, variation at the Berry ligament in 112 （5.94%） nerves, variation at the cricothyroid joint in 17 （ 0. 80% ） nerves, and 6 （ 0. 32% ） cases of non-recurrent laryngeal nerve （nRLN）. Conclusions Variations in RLN found during thyroid surgery are of relatively high incidence, complex and diverse, which can be a potential reason of nerve injury due to visual misidentification. Thus, a thorough knowledge of the normal anatomy of RLN and its anatomic variations ensures a safe and effective thyroid surgery.

关 键 词：甲状腺疾病 甲状腺切除术 喉返神经 解剖变异 

分 类 号：R653[医药卫生—外科学]