非返性喉返神经的术前CT预判及术中保护策略探讨  

Preoperative CT prediction and intraoperative protection strategy of non-recurrent laryngeal nerve

作　　者：彭友 潘钢[1] 周力 张煜 时晶晶 PENG You;PAN Gang;ZHOU Li;ZHANG Yu;SHI Jingjing(Department of Oncological Surgery,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hang-zhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院肿瘤外科,310006

出　　处：《浙江医学》2022年第13期1402-1406,I0007,共6页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF22H070008);浙江省医药卫生科技计划项目(2021KY850);杭州市医药卫生科技项目(OO20191087)。

摘　　要：目的探讨甲状腺手术术前颈部增强CT预判和术中识别保护非返性喉返神经的诊治策略。方法回顾性分析2013年3月至2020年2月浙江大学医学院附属杭州市第一人民医院收治的术前均行颈部增强CT检查的3166例甲状腺手术患者的临床资料,术中常规显露颈段全程喉返神经,总结分析非返性喉返神经的术前颈部增强CT预判与术中解剖特点及识别保护情况。结果3166例患者手术中发现非返性喉返神经变异38例(1.2%),均位于右侧,均存在右锁骨下动脉的变异(发出位置及走行异常);Toniato分型非返性喉返神经1型2例,2a型23例,2b型11例,非返性喉返神经与同侧喉返神经并存2例。结论甲状腺手术术前通过颈部增强CT检查识别变异的右锁骨下动脉,有利于放射科医生和外科医生术前、术中预判非返性喉返神经存在的可能,术中采用精细化被膜解剖技术,可减少神经损伤的风险。Objective To predict the non-recurrent laryngeal nerve before thyroidectomy with cervical enhanced CT scan and to discuss the intraoperative protection strategy for it.Methods Clinical data of 3166 patients undergoing thy-roid surgery in Hangzhou First People's Hospital from March 2013 to February 2020 were retrospectively analyzed.Patients received cervical enhanced CT scan before the surgery and during the operation,the entire cervical recurrent laryngeal nerve was routinely exposed.The predictive value of preoperative cervical enhanced CT scan was assessed and the intra-operative anatomical features,identification and protection of non-recurrent laryngeal nerve was discussed.Results In 3166 patients,38 cases(1.2%)were found to have non-recurrent variation of laryngeal nerve,all of which were located on the right side and had abnormalities in the right subclavian artery(abnormal origin and running).According to Toniato classi-fication,there were 2 cases of non-recurrent laryngeal nerve type 1,23 cases of type 2a,11 cases of type 2b,and 2 cases of coexistence of non-recurrent laryngeal nerve and ipsilateral recurrent laryngeal nerve.Conclusion It is helpful for radi-ologists and surgeons to predict the possibility of non-recurrent recurrent laryngeal nerve by using enhanced CT scan be-fore thyroidectomy,and it is suggested to use fine capsular dissection to reduce the risk of nerve injury.

关 键 词：甲状腺切除术 非返性喉返神经 喉返神经 计算机断层扫描 

分 类 号：R653[医药卫生—外科学]