甲状腺癌患者手术中喉返神经的显露及损伤后治疗  

Discussion of exposure of the intraoperative recurrent laryngeal nerve and treatment after the injury in the thyroid carcinoma patients

作　　者：任婉丽[1] 汪世洋 李化静[1] 姚小宝[1] 白艳霞[1] 邵渊[1] 

机构地区：[1]西安交通大学第一附属医院耳鼻咽喉-头颈外科,西安710061

出　　处：《山西医科大学学报》2016年第5期478-480,共3页Journal of Shanxi Medical University

摘　　要：目的探讨在甲状腺癌手术中喉返神经（recurrent laryngeal nerve,RLN）的显露及损伤后的治疗。方法对本院耳鼻喉科自2015-08~2015-11收治的38例甲状腺癌的患者,行甲状腺全切手术及颈部淋巴结廓清术者32例,术后常规行131I治疗者32例,行甲状腺部分切除及患侧颈Ⅵ区淋巴结清扫者6例,对这些患者的临床资料进行分析总结。结果所有甲状腺癌患者手术中均清晰显示喉返神经,术后B超显示无腺叶残留。术中1例（2.6%）发生RLN损伤,术中即行一期RLN断端吻合术。术后3例患者出现声嘶症状,2例患者3月内发音恢复正常,1例患者未恢复。结论 RLN在甲状腺癌术中被损伤的机率较高,影响因素较多,术中正确的解剖显露RLN对保护喉返神经功能和甲状腺腺叶的完整切除具有重要的意义。如果术中出现喉返神经离断,视离断部位及张力情况及时行喉返神经断端吻合或喉返神经与颈袢神经行断端吻合,术后配合激素、雾化吸入及营养神经等治疗有良好疗效。Objective To explore the exposure of the recurrent laryngeal nerve（ RLN） and treatment after the injury of the RLN in the thyroid carcinoma operation. Methods Thirty-eight thyroid carcinoma patients were collected in the otolaryngology department of the hospital from August 2015 to November 2015. Six patients underwent unilateral thyroid gland partial resection operation combined with unilateral neck dissection,and thirty-two patients underwent the total thyroidectomy combined with neck dissection and131 I ablation treatment routinely. The clinical data were retrospectively analyzed. Results Recurrent laryngeal nerves were clearly exposed in all the patients during the operation,and B ultrasound showed no thyroid gland residue after operation. RLN of one patient（ 2. 6%） was damaged during the operation and received the anastomosis. The hoarseness symptom occurred in 3 patients after the operation,of which,pronounciation of two patients recovered in the three months and one case failed. Conclusion The incidence of the RLN＇s injury is high in the thyroid carcinoma operation with multiple influential factors,and the correct anatomy and exposure of RLN is of high significance for protecting its function and completely removing the thyroid gland. If the transection of RLN occurres,the RLN＇s stump anastomosis or the anastomosis between RLN distal stump and the neck loop should be performed timely based on the transection site,cooperated with the hormone,atomization inhalation and neurotrophic treatment,and the treatment is effective.

关 键 词：甲状腺癌 喉返神经 甲状腺切除术 

分 类 号：R736.1[医药卫生—肿瘤]