甲状腺术中喉返神经入喉处变异临床研究(附2404例报告)  

Variationattheentryof therecurrent laryngeal nerve intothelarynx in thyroidectomies: A report of 2404 cases

作　　者：邵堂雷[1] 蒋晓[2] 王振乾[2] 黄河[2] 郭建强[2] 吴志浩[3] 丁昊[3] 殷佳晗[3] 杨卫平[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025 [2]上海解放军第八五医院普外科,上海200052 [3]上海交通大学医学院附属瑞金医院远洋分院普外科,上海200031

出　　处：《中国实用外科杂志》2014年第9期880-882,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨我国甲状腺术中喉返神经入喉处的变异。方法回顾性分析2007年1月至2013年12月上海交通大学医学院附属瑞金医院共施行的2404例显露颈段喉返神经的甲状腺手术,解剖喉返神经3275根,左侧1576根,右侧1699根。结果有647根喉返神经存在入喉处变异,占19.8%(647/3275)。包括入喉处扇形膨大变异234根,占7.2%(234/3275)。入喉处分支变异376根,占11.5%(376/3275)。入喉处远离环甲关节变异37根,占1.1%(37/3275)。第一类变异右侧发生率高于左侧,后两类变异左侧发生率高于右侧。第一类变异较国外报道高,第二类变异较国外报道低,第三类变异国外未见报道。后两类变异神经术后麻痹的发生率要高于正常神经。结论喉返神经入喉处存在膨大变异、分支变异和远离环甲关节三类变异。其中后两类变异术后麻痹发生率较高,需引起重视。Objective To study the variation at the entry of the recurrent laryngeal nerve into the larynx.Methods A prospective study involving 2404 consecutive thyroidectomies was performed during January 2007 and December 2013 in Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine. A total of 3275 RLNs were dissected and 1576 RLNs were in left and 1699 RLNs in right.Results A total of 647 RLNs（19.75%） have been found with variation at the entry into the larynx. There were three types. Type one： the fanwise fashion variation atthe entry into the larynx in 234（7.15%） RLNs; Type two： the extralaryngeal branching variation at the entry into thelarynx in 376（11.48%） RLNs; Type three： the entry of RLN far from the posterior of cricothyroid joint in 37（1.13%）RLNs. The variation rate of right RLNs was higher than that of left RLNs in type one,but the variation rate of left RLNswas higher than that of right RLNs in type two and three. Compared with the foreign reports,the variation rate of type onewas higher than that of in foreign reports,but the rate of type two was lower than that of in foreign reports. Type three had not been reported in foreign reports. The incidence of postoperative RLN palsy was higher in type two and three.Conclusion There are three variation types of RLN at the entry into the larynx including the fanwise fashion andextralaryngeal branching and the entry of RLN far from the posterior of the cricothyroid joint. Because of the higherincidence of postoperative RLN palsy in type two and three,it should be paid more attention to the variation at the entry of RLN into the larynx.

关 键 词：甲状腺切除术 喉返神经 入喉处变异 

分 类 号：R6[医药卫生—外科学]