胸骨后甲状腺肿手术喉返神经保护的临床研究  

Clinical research of recurrent laryngeal nerve protection in substernal goiter

作　　者：吴佳龙 朱岩[1] 杨长东[1] 金德斌[1] 杨艳 张伯阳 马忠锋[1] WU Jialong;ZHU Yan;YANG Changdong;JIN Debin;YANG Yan;ZHANG Boyang;MA Zhongfeng(Department of Head and Neck Surgery,the First Hospital of Qinhuangdao,Qinhuangdao,Hebei,066000,China)

机构地区：[1]秦皇岛市第一医院头颈外科,河北秦皇岛066000

出　　处：《中国耳鼻咽喉头颈外科》2022年第5期290-292,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：秦皇岛市重点研发计划科技支撑项目(201902A086)。

摘　　要：目的 探讨胸骨后甲状腺肿手术中喉返神经的走行规律及保护技巧。方法 回顾性分析秦皇岛市第一医院2018年3月~2022年2月收治的130例胸骨后甲状腺肿手术患者的临床资料。结果 130例胸骨后甲状腺肿手术患者,双侧102例,单侧28例。胸骨后甲状腺肿来源于甲状腺腺体100例,来源于Zuckerkandl结节30例。共显露喉返神经232条,左侧114条,右侧118条。左侧喉返神经位置正常110条,异位4条,右侧喉返神经位置正常104条,异位14条,两侧喉返神经位置比较,右侧异位率高于左侧(χ^(2)=5.656,P<0.05)。来源于甲状腺腺体的显露喉返神经185条,喉返神经位置正常175条,异位10条。来源于Zuckerkandl结节的显露喉返神经47条,喉返神经位置正常39条,异位8条。不同来源两组喉返神经位置比较,来源于Zuckerkandl结节异位率高于腺体来源(χ^(2)=5.536,P<0.05)。结论 胸骨后甲状腺肿手术中应时刻警惕喉返神经异位情况,右侧喉返神经较左侧更易发生异位,肿物来源于Zuckerkandl结节时,喉返神经更易发生异位。OBJECTIVE To investigate the regulation and protection technique of recurrent laryngeal nerve in substernal goiter.METHODS The clinical data of 130 patients with substernal goiter were retrospectively analyzed from March 2018 to February 2022.RESULTS Of the 130 patients with substernal goiter,102 were bilateral and 28 unilateral lesions.The substernal goiter from thyroid gland were 100 cases and from Zuckerkandl tubercle were 30 cases.232 recurrent laryngeal nerves were exposed,including 114 on the left side and 118 on the right.The left recurrent laryngeal nerves in the normal position were 110,and 4 cases were ectopic.The right in the normal position were 104,and 14 cases were ectopic.The ectopic rate on the right side was higher than that on the left(χ^(2)=5.656,P<0.05).Substernal goiter derived from the thyroid gland exposed 185 recurrent laryngeal nerves,175 of which were normal position and 10 were ectopic.The operation from Zuckerkandl tubercle exposed 47 recurrent laryngeal nerves,39 of which were normal position and 8 ectopic.The ectopic rate of recurrent laryngeal nerves of the goiters from Zuckerkandl tubercle was higher than that from thyroid gland(χ^(2)=5.536,P<0.05).CONCLUSION In substernal goiter,the ectopic recurrent laryngeal nerve should be vigilant.The right recurrent laryngeal nerve is more easily ectopic than the left.The recurrent laryngeal nerve is more easily ectopic when the substernal goiter from Zuckerkandl tubercle.

关 键 词：甲状腺肿 胸骨后 喉返神经 Zuckerkandl结节 

分 类 号：R653[医药卫生—外科学]