右侧同时存在喉不返神经和喉返神经一例及文献复习  

A case report of coexisting right non-recurrent laryngeal nerve and recurrent laryngeal nerve and literature review

作　　者：罗舟 符德元 章佳新 LUO zhou;FU de-yuan;ZHANG jia-xin(Department of Thyroid and Breast Surgery in Northern Jiangsu Province Hospital,Yangzhou,Jiangsu Province 225000,China)

机构地区：[1]苏北人民医院甲状腺乳腺外科310病区,江苏扬州225000

出　　处：《解剖学研究》2022年第1期65-68,75,共5页Anatomy Research

基　　金：国家自然科学基金面上项目(82072909)。

摘　　要：目的报道甲状腺术中发现右侧同时存在喉不返神经及喉返神经的罕见变异一例,结合相关文献探讨其解剖特点及术中注意事项。方法回顾分析江苏省苏北人民医院甲乳外科收治的一例右侧同时存在喉不返神经及喉返神经结节性甲状腺肿患者的临床资料。在万方数据库、中国知网、Pubmed中,以"喉不返神经(non-recurrent laryngeal nerve)"和"喉返神经(recurrent laryngeal nerve)"为关键词,检索2021年7月前的文献,检索出相关文献9篇共15例病例英文文献报道,未检索出相关中文文献,并对相关文献进行归纳总结。结果本文喉不返神经与喉返神经同时存在的情况发生在右侧,且不存在右侧锁骨下动脉异常起源于主动脉弓情况,喉不返神经与喉返神经直径相近,喉返神经直径正常;文献报道的15例病例,同侧喉不返神经和喉返神经同时存在的情况都发生在右侧;排除1例文献没有交代的病例,11/14的病例出现喉返神经直径变细的情况;排除9例文献没有交代的病例,4/6的病例出现右侧锁骨下动脉异常起源于主动脉弓的情况。结论同侧同时存在喉不返神经及喉返神经的情况极其罕见,一般发生在右侧,术中应考虑到此种情况存在的可能,尤其是发现喉返神经较细和术前检查提示右侧锁骨下动脉异常起源于主动脉弓时。Objective To report a rare case that non-recurrent laryngeal nerve and recurrent laryngeal nerve was found in the right side during thyroid surgery,the anatomic characteristics and intraoperative precautions were discussed in combination with relevant literatures. Methods The clinical data of the nodular goiter patient with co-existing ipsilateral non-recurrent laryngeal nerve and recurrent laryngeal nerve in the right side was retrospected,the literatures about co-existing ipsilateral non-recurrent laryngeal nerve and recurrent laryngeal nerve were searched in wanfang,CNKI,Pubmed database by using“non-recurrent laryngeal nerve”and“recurrent laryngeal nerve”as key words before July 2021,nine literatures were detected in Pumed,no literature was detected in CNKI and wanfang database,there were fourteen cases reported in the nine literatures.And we reviewed those literatures to find the characteristic of the situation. Results The case we reported co-existing ipsilateral non-recurrent laryngeal nerve and recurrent laryngeal nerve in the right side,CT examination reveal that there was no abnormal origin of the right subclavian artery from the aortic arch,the diameter of recurrent laryngeal nerve is normal.Combining with the literatures,the rare situation co-existing ipsilateral non-recurrent laryngeal nerve and recurrent laryngeal nerve was found in the right side,the literatures which didn’t report relevant information were excepted,11/14 patients’ diameter of recurrent laryngeal nerve were thinner,only 4/6 patients existed abnormal origin of the right subclavian artery from the aortic arch. Conclusion The case with ipsilateral non-recurrent laryngeal nerve and recurrent laryngeal nerve is rare,but we should think about the probability of this rare situation,especially when we found the diameter of recurrent laryngeal nerve is thinner than normal,and abnormal origin of the right subclavian artery from the aortic arch is not always present in this rare case.

关 键 词：喉不返神经 喉返神经 甲状腺 甲状腺手术 

分 类 号：R653[医药卫生—外科学]