甲状腺肿瘤术中喉上神经外支解剖观察及功能保护  

Study on the physiological anatomy and function protection of EBSLN during thyroid surgery

作　　者：马泓智[1] 房居高[1] 侯丽珍[1] 钟琦[1] 冯凌[1] 李平栋[1] 何时知 时倩[1] Ma Hongzhi;Fang Jugao;Hou Lizhen;Zhong Qi;Feng Ling;Li Pingdong;He Shizhi;Shi Qian(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing Key Laboratory of Head and Neck Pathology,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京市头颈部分子病理重点实验室,北京100730

出　　处：《国际耳鼻咽喉头颈外科杂志》2020年第1期1-5,共5页International Journal of Otolaryngology-Head and Neck Surgery

基　　金：首都卫生发展科研专项自主创新项目(2018-2-2054);北京市医管局杨帆计划(2018);北京市科委首都临床特色应用研究重点项目(Z141107002514003);北京市医院管理局登峰人才培养计划(DFL20180202);中国健康促进基金会2019甲状腺中青年医师研究项目。

摘　　要：目的 观察甲状腺肿瘤手术中喉上神经的解剖位置及与周围结构的关系.方法 对同—术者手术的100侧甲状腺叶切除中,喉上神经外支的解剖位置、毗邻关系,以甲状腺上动脉前支进入腺体位置为参照点进行解剖测量.结果 参照Cernea分型,Ⅰ型占43%,Ⅱa型占50%,Ⅱb型占6%,不确定占1%;喉上神经外支从甲状腺上动脉分出后至甲状腺上动脉进入甲状腺间的平均距离为8.54 mm,双侧喉上神经外支的位置没有对称性,与上动脉入腺体的距离也和肿瘤的大小没有显著性差异.结论 大部分喉上神经外支(56%)位于容易损伤的位置,手术中应显露神经后再结扎甲状腺上血管.Objective To Investigate the anatomy features of external branch of superior laryngeal nerve(EBSLN)during thyroidectomy.Methods 83 patients who had undergone total thyroidectomy or lobectomy by the same surgeon were studied.Totally,100 lobectomy cases were dissected.The physiological anatomic location of EBSLN,the relationship of EBSLN with its surrounding structures,and the distance between the point where EBSLN separated from the superior thyroid artery(STA)and the point where STA joined the thyroid was measured accurately.Results Among the studied cases,Cernea Type I occurred in 43%cases,Cemea Type Ila occurred in 50%cases,Cernea Type lib occurred in 6%cases,and uncertain cases occurred in 1%.The mean distance between the point where EBSLN separated from the superior thyroid artery(STA)and the point where STA joined the thyroid was 8.54 mm.No significant difference was found between the left side EBSLN and right side in the same patient.Also,no anatomic association was found between the location of EBSLN and the size of the tumor.Conclusion In most cases(56%),ENSLN occurs closely to the thyroid superior pole under physiological conditions,and it is prone to be injured during thyroid surgery.EBSLN should be exposed before the ligation of STA.

关 键 词：甲状腺肿瘤 外科手术 解剖 喉上神经外支 

分 类 号：R736.1[医药卫生—肿瘤]