甲状腺切除术甲状腺背侧支血管在喉返神经定位中的价值分析  

The Value of Thyroid Dorsal Branch Vessel in the Localization of the Recurrent Laryngeal Nerve during Thyroidectomy

作　　者：田野[1] 白超[1] 李新喜[1] 杨镇玮[1] 张磊[1] 罗军[1] TIAN Ye;BAI Chao;LI Xin-xi;YANG Zhen-wei;ZHANG Lei;LUO Jun(Department of Vascular and Thyroid Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院血管甲状腺外科,新疆乌鲁木齐830000

出　　处：《中国现代手术学杂志》2021年第4期266-270,共5页Chinese Journal of Modern Operative Surgery

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题基金(SKL-HIDCA-2020-20)。

摘　　要：目的探讨甲状腺背侧支血管在甲状腺切除术中定位喉返神经的价值。方法回顾性分析2014年1月至2018年3月在我科行甲状腺切除术的484例患者的临床资料,其中271例(474侧叶,实验组)术中通过甲状腺背侧支血管定位喉返神经,213例(400侧叶,对照组)采用常规中间路径暴露喉返神经。比较两组手术时间和喉返神经损伤率,分析甲状腺背侧支血管的解剖特点及与喉返神经的位置关系。结果实验组采用甲状腺背侧支血管定位,单侧叶切除时间平均(33.42±17.81)min,喉返神经损伤率为0.63%(3/474),均为迟发型声音嘶哑;对照组单侧叶切除时间平均(46.19±19.43)min,喉返神经损伤率为2.25%(9/400),其中切断性损伤1例,电刀灼伤3例,钳夹损伤2例,分离挫伤1例,迟发性声音嘶哑2例。实验组单侧叶切除时间及喉返神经损伤率均少于对照组(P<0.01)。实验组定位血管出现率为91.77%(435/474),直径约2~3 mm,其中位于喉返神经浅面者为88.74%,位于神经深面者为11.26%;以动脉形式出现者占80.92%,以静脉形式出现者占19.08%。定位血管距离甲状腺软骨下角平均(1.26±0.36)cm,以喉返神经近入喉处和近下位甲状旁腺处多见。根据其与喉返神经伴行的相对关系可分为:①Ⅰ型,动脉双支垂直型65.98%;②Ⅱ型,静脉双支垂直型16.55%;③Ⅲ型,神经深面垂直型11.26%;④Ⅳ型,动静脉垂直神经型3.45%;⑤Ⅴ型,伴行神经型2.76%。结论掌握甲状腺背侧支血管的解剖特点与走行规律,提高辨认技巧,可有效提高甲状腺切除术中定位喉返神经的效率,缩短手术时间,降低喉返神经损伤率和损伤程度。Objective To explore the value of a thyroid dorsal branch vessel in the localization of the recurrent laryngeal nerve(RLN)during thyroidectomy.Methods The clinical data of 484 cases underwent thyroidectomy from January 2014 to March 2018 were reviewed retrospectively.During the operation,the RLN was located by a thyroid dorsal branch anonymous vessel in 271 cases(474 lateral lobes,as the experimental group),and was exposed by routine intermediate approach in 213 cases(400 lateral lobes,as the control group).The operation time and injury incidence of RLN were compared between the two groups,and the anatomic characteristics of the thyroid dorsal branch anonymous vessel and the relationship between the localization vessel and RLN were studied.Results The average unilateral lobectomy time was(33.42±17.81)min,and the incidence of RLN injury was 0.63%(3/474),which was delayed hoarseness in the experimental group.The average unilateral lobectomy time was(46.19±19.43)min,and the incidence of RLN injury was 2.25%(9/400),including 1 case of cut-off injury,3 cases of electric knife burns,2 cases of clamp injury,1 case of separation contusion and 2 cases of delayed hoarseness in the control group.There was statistical difference in the unilateral lobectomy time and the RLN injury rate between the two groups(P<0.01).In the experimental group,the occurrence rate of the locating anonymous vessel of the thyroid dorsal branch was 91.77%(435/474)with the diameter of 2 to 3 mm,and was found more common in the RLN near larynx and the lower parathyroid gland.Among them,88.74%located on the superficial side and 11.26%on the deep side of the RLN;80.92%appeared in form of artery and 19.08%of vein.The average distance between the thyroid dorsal branch vessel and the inferior angle of thyroid cartilage was(1.26±0.36)cm.The localization vessel was divided into 5 types according to the relative concomitant relationship between it and RLN:TypeⅠ,the vertical double branches of artery(65.98%);TypeⅡ,the vertical double branches of vein(1

关 键 词：喉返神经定位 解剖 血管穿支 甲状腺切除术 

分 类 号：R653[医药卫生—外科学]