甲状腺术中喉不返神经的解剖特点及神经监测的使用  

The anatomical characteristics of nonrecurrent laryngeal nerve and intraoperative nerve monitoring in thyroid surgery

作　　者：龙克艰 杨超 吴强[1] 查炜[1] LONG Kejian;YANG Chao;WU Qiang;ZHA Wei(Department of General Surgery,First People’s Hospital of An Qing,Anqing 246004,Anhui Province,China)

机构地区：[1]安庆市第一人民医院普外科,安徽安庆246004

出　　处：《中国癌症杂志》2021年第10期927-931,共5页China Oncology

摘　　要：背景与目的:喉不返神经(nonrecurrent laryngeal nerve,NRLN)虽然较为罕见,但在甲状腺手术中有重要意义。探讨NRLN的解剖特点及术中神经监测(intraoperative neuromonitoring,IONM)的临床意义,以便外科医师在手术过程中更好地保护NRLN的功能,降低神经损伤的风险。方法:选取2015年1月—2020年9月安庆市第一人民医院普外科收治的甲状腺手术并在术中暴露喉返神经(recurrent laryngeal nerve,RLN)的患者共1600例作为研究对象。回顾性分析NRLN的暴露及损伤情况。术中应用神经监测技术检测迷走神经和喉返神经的功能。结果:1600例患者术中暴露喉返神经总数为2312根,其中发现NRLN 5例(0.31%)。右侧NRLN全部发现,其中Ⅰ型2例,ⅡA型1例,ⅡB型2例。术中NRLN暴露时间为(11.38±1.59)min。术前CT提示5例患者的右侧锁骨下动脉均直接从主动脉弓发出。无相关术后并发症发生。结论:NRLN发生率低,且多发生在右侧。如果术前检查提示锁骨下动脉变异,则应考虑NRLN的存在。在术中神经监测技术的帮助下,可以及时发现NRLN,从而有效地避免并发症的发生。Background and purpose: Nonrecurrent laryngeal nerve(NRLN) is rare but important for thyroid surgery. This study aimed to explore the anatomical characteristics of NRLN and the clinical significance of intraoperative neuromonitoring(IONM),so that surgeons could better protect the function of NRLN during surgery and reduce the risk of nerve injury. Methods: A total of 1600 patients with recurrent laryngeal nerve(RLN) exposure in thyroid surgery who were treated at Department of General Surgery in First People’s Hospital of Anqing, from January 2015 to September 2020, were selected as the study subjects. The exposure and injury of NRLNs were analyzed retrospectively. IONM of vagus nerve and RLN was used for detecting the function of nerves.Results: The total number of RLNs exposed during the operation was 2 312 in 1 600 patients, of which 5 patients with NRLNs(0.31%)were found. All NRLNs were found on the right side, including 2 cases of type Ⅰ, 1 case of type ⅡA and 2 cases of type ⅡB. The exposure time of NRLN was(11.38±1.59) minutes. All the 5 patients had aberrant subclavian artery that arose directly from the aortic arch detected by preoperative CT scanning. No related postoperative complication occurred. Conclusion: The incidence of NRLN is low, and most of them exist on the right side. If preoperative examination indicates the variation of subclavian artery, the existence of NRLN should be considered. With the help of IONM, NRLN can be found in time, and complications can be effectively avoided.

关 键 词：甲状腺手术 喉不返神经 神经监测 

分 类 号：R736.1[医药卫生—肿瘤]