甲状腺全切除术中三种显露喉返神经的方法及效果  

Three methods of exposing recurrent laryngeal nerve in total thyroidectomy and corresponding effects

作　　者：王贵 韩建成[1] 秦跃辉 Wang Gui, Han Jiancheng, Qin Yuehui(The Second Department of General Surgery, Puyang People＇ s Hospital, Puyang 457000, Chin)

机构地区：[1]河南省濮阳市人民医院普外二科,457000

出　　处：《中国实用医刊》2018年第2期64-66,共3页Chinese Journal of Practical Medicine

摘　　要：目的 研究甲状腺全切除术中三种显露喉返神经方法 及效果.方法 选取180例接受甲状腺全切术患者为研究对象,在全身麻醉效果满意后,结合患者病情术中采取侧方入路、下方入路及上方入路方法显露喉返神经,并观察喉返神经显露结果 .结果 解剖出来的喉返神经共225条,包括121条右侧与104条左侧,双侧显露有45例;喉返神经在患者甲状腺下动脉总干深面处经过的有117条;动脉总干浅面处经过的有19条;动脉分支深面处经过的有42条;动脉分支浅面处经过的有23条;于动脉分支间隔部位经过的有15条;神经分支以及动脉分支交叉部位穿过的有9条.于喉返神经入喉前,173条存在分支;52条没有分支,喉不返神经1条;初治甲状腺癌1例,神经穿入肿瘤不能分离,故需同时切除肿瘤与神经;1例外院术后声音嘶哑,术中探查显示神经被切断.结论 由于甲状腺病变具有较高多样性,且喉返神经解剖路径十分复杂,故全切术中应结合实际情况合理选择下方、上方与侧方不同喉返神经显露方法,能避免或减少喉返神经损伤.Objective To investigate three methods of exposing recurrent laryngeal nerve and their effects in total thyroidectomy. Methods One hundred and eighty patients who underwent total thyroidectomy were selected as the research objects,after the general anesthesia effect was satisfied,the lateral laryngeal ap-proach,the inferior approach and the upper approach were chosen to expose the recurrent laryngeal nerve ac-cording to the patient＇s condition,the results of the recurrent laryngeal nerve were observed. Results A total of 225 recurrent laryngeal nerves were dissected,including 121 right and 104 left sides,with 45 bilateral expo-sure,there were 117 recurrent laryngeal nerves in the deep trunk of the inferior thyroid artery,19 lines passing through the superficial portion of the arterial trunk,42 lines passing through the deep branch of the artery,23 lines passing through the superficial branch of the artery,15 branches passing through the branches of the ar-terial branches,9 lines passing through the branches of the nerve and the branches of the arterial branches. There were 173 branches in the laryngeal nerve before entering the larynx;52 nerves had no branches and 1 nerve did not return to the larynx;1 case had primary thyroid cancer,the nerve penetrating tumor can not be separated,so it was necessary to resect the tumor and nerve simultaneously;1 case had postoperative hoarse-ness,intraoperative examination showed nerve was cut off. Conclusions Because of the high diversity of thy-roid lesions and the complex anatomical pathway of the recurrent laryngeal nerve,it is necessary to select the method of exposing the lower,superior and lateral laryngeal nerve according to the actual situation in order to avoid or reduce the recurrent laryngeal nerve injury.

关 键 词：甲状腺全切术 显露 喉返神经 方法 效果 

分 类 号：R653[医药卫生—外科学]