甲状腺手术中显露喉返神经的方法  

Methods for exposure of recurrent laryngeal nerve in thyroid surgery

作　　者：马向东[1] 韩锡林[1] 刘涛[1] 寇昌华[1] 

机构地区：[1]徐州市中心医院肿瘤外科,221009

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第10期861-863,共3页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 分析甲状腺手术中因病变部位不同结合喉返神经解剖路径而采用不同的显露喉返神经入路的方法,以避免喉返神经的损伤.方法 回顾性分析755例行甲状腺手术患者的资料,所有患者均在全身麻醉下进行,术中根据病变情况决定手术切除范围,结合喉返神经的解剖路径,术中常规显露喉返神经.结果 755例患者中共显露喉返神经963条,采用侧方入路显露658条、下方入路显露106条、上方入路显露199条;喉返神经位于甲状腺下动脉干深面通过694例、位于动脉干浅面通过119例、在动脉分支之间通过98例、神经分支与动脉分支交叉穿过者62例;喉返神经入喉前分支者578例、未分支直接入喉者385例,发现喉不返神经2例.外院术后声嘶6例中,术中探查发现神经被完全切断2例、神经被结扎4例;1例为初次术前即有声嘶,其余病例无一例发现术后声嘶.结论 甲状腺病变的多样性及喉返神经解剖路径的复杂性,要求术中须根据具体情况灵活应用上方、侧方,下方入路解剖显露喉返神经,可降低喉返神经损伤的风险.Objective To evaluate different methods to explose recurrent laryngeal nerve （RLN）based on the location of thyroid diseses and anatomic path of the RLN,to avoid the RLN damage in thyroid surgery.Methods A total of 755 cases underwent total lobectomy was studied retrospectively.RLN was explosed in each case.Results A total of 963 RLN was exposed in 755 cases,among those 658 RLN were exposed by lateral approach,106 by inferior approach,and 199 by superior approach.It was showed that 694 RLN traveled deep to the inferior throid artery and 119 superficial to the artery,98 through between two branches of the artery,and 62 with the cross of the nerve branches and the artery branches.Before entering larynx,578 RLN gave off branches and 385 had no branches.Non-recurrent laryngeal nerves were found in 2 cases.There were 6 cases who presented with hoarseness after thyroidectomy and undergoing reexploration,among them RLN were legated in 4 cases and severed in 2 cases.Conclusions The anatomic relation of RLN is relatively complicated.Lateral,inferior or superior aproach may be used for exposure of RLN to decrease risks of injury to the nerve.

关 键 词：甲状腺切除术 喉返神经 神经解剖学 

分 类 号：R653[医药卫生—外科学]