甲状腺患者喉不返神经的术前影像诊断和术中监测  

Preoperative diagnosis by imaging examination and intraoperative monitoring of non-recurrent laryngeal nerve of patients with thyroid disease

作　　者：郑海涛[1] 杜柏荣[2] 郝少龙[1] 宁进尧[1] 李宝元[1] 王东[1] 姜立新[1] 

机构地区：[1]青岛大学附属烟台毓璜顶医院甲状腺外科,264000 [2]山东省邹城市人民医院普通外科,274000

出　　处：《中华普外科手术学杂志（电子版）》2015年第6期32-34,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：烟台市科技发展计划项目(2011228)~~

摘　　要：目的总结和分析甲状腺手术中喉不返神经的病例及影像资料。方法回顾性分析了2009年到2014年间喉不返神经8例患者,探讨非返性喉返神经的术前判定和术中识别及保护技巧。结果所有患者术前均行颈部增强CT和颈部超声,4例患者术前超声提示迷走锁骨下动脉。甲状腺增强CT术前判定8例。术中常规暴露喉返神经,在正常位置未见喉返神经,均证实为非返性喉返神经,平均手术时间为58 min,喉返神经寻找时间约12 min,术后发音良好,双侧声带活动正常。结论术前颈部增强CT和颈部血管超声检查发现食管后方异常右锁骨下动脉,提示右侧非返性喉返神经存在,术中仔细操作,有助于避免损伤。Objective To summarize the experiences with preoperative imaging examination,intraoperative monitoring of the non-recurrent laryngeal nerve（ NRLN） during thyroidectomy. Methods From January 2009 to December 2014,clinical data of 8 patients with NRLN were retrospectively analyzed,both preoperative identification and intraoperative monitoring of the NRLN were discussed. Results All of the 8patients were subjected to preoperative neck enhanced CT and ultrasound. The preoperative neck enhanced CT showed abnormal right subclavian artery behind the esophagus in all 8 patients,whereas 4 paptients were confirmed by ultrasound. The recurrent laryngeal nerve routinely exposed during thyroidectomy was confirmed as the NRLN. The mean operative time was 58 minutes,and the average NRLN detection time was 12 minutes. After operation,the 8 patients had a good pronounciation with normal activity of the bilateral vocal cords. Conclusion Preoperative cervical enhanced CT and ultrasound could detect abnormal right subclavian artery behind the esophagus,suggesting the existence of the right NRLN,and could help to avoid injury during operation.

关 键 词：甲状腺疾病 甲状腺切除术 喉返神经 锁骨下动脉 

分 类 号：R653[医药卫生—外科学]