甲状腺手术相关非返喉神经的临床特征与预判策略  

Clinical characteristics and prediction strategy of non-recurrent laryngeal nerve related to thyroid surgery

作　　者：李培鑫[1] 秦胜旗[1] 王今[1] 赵宁[2] 葛智成[2] 滕长胜[2] 张忠涛[2] 屈翔[2] LI Peixin;QIN Shengqi;WANG Jin;ZHAO Ning;GE Zhicheng;TENG Changsheng;ZHANG Zhongtao;QU Xiang(Department of Comprehensive Surgery,Medical and Health Center,Beijing Friendship Hospital,Capital Medical University,Beijing100050,China;Branch Center,Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing100050,China)

机构地区：[1]首都医科大学附属北京友谊医院医疗保健中心综合外科,北京100050 [2]首都医科大学附属北京友谊医院普通外科分中心,北京100050

出　　处：《中国医药导报》2023年第14期111-117,共7页China Medical Herald

基　　金：国家重点研发计划项目(2017YFC0110900)。

摘　　要：目的探讨甲状腺手术相关的非返喉神经(NRLN)的临床特征与预判策略。方法回顾性分析首都医科大学附属北京友谊医院医疗保健中心综合外科(以下简称“我科”)2009年8月至2022年2月因甲状腺良、恶性肿瘤行甲状腺手术的175例患者的临床资料;另外以“非返喉神经”“喉不返神经”“非返性喉下神经”“喉返神经”“喉下神经”“non-recurrent laryngeal nerve”“non recurrent laryngeal nerve”“non-recurrent inferior laryngeal nerve”“recurrent laryngeal nerve”“inferior laryngeal nerve”“NRLN”“NRILN”为检索词在中国知网、万方、PubMed及Web of Science数据库检索研究对象为中国人的文献,检索时间为2012年1月至2022年2月,统计NRLN总发生率、右侧发生率、Stewart分型、损伤率,以及术前应用影像学预判NRLN的结果。结果我科术中发现1条右侧NRLN,StewartⅠ型,NRLN总发生率为0.32%,右侧发生率为0.63%,所有患者术中无损伤。meta分析显示,NRLN总发生率为0.46%(95%CI:0.26%~0.66%);右侧发生率为0.45%(95%CI:0.22%~0.68%);StewartⅠ型发生率为76.47%(95%CI:58.61%~94.33%),Ⅱ型发生率为23.53%(95%CI:5.67%~41.39%);损伤率为10.20%(95%CI:2.93%~17.47%)。影像学预判结果显示,90%(81/90)存在异形右侧锁骨下动脉;CT预测NRLN的漏诊率为19.23%,胸部X线预测NRLN误诊率为56.67%,超声预测NRLN漏诊率为7.25%。结论NRLN为少见变异,术中损伤率高,术前可通过影像学预判,CT及超声预测NRLN准确性较高。Objective To investigate the clinical characteristics and prediction strategy of non-recurrent laryngeal nerve(NRLN)related to thyroid surgery.Methods The clinical data of 175 patients who underwent thyroid surgery for benign and malignant thyroid tumors from August 2009 to February 2022 in Department of Comprehensive Surgery,Medical and Health Center,Beijing Friendship Hospital(hereinafter referred to as“our department”)were retrospectively analyzed;in addition,only enroll Chinese patients as study objectives in CNKI,Wanfang,PubMed,and Web of Science database were retrieved by using“non-recurrent laryngeal nerve”,“non recurrent laryngeal nerve”,“non-recurrent inferior laryngeal nerve”,“recurrent laryngeal nerve”,“inferior laryngeal nerve”,“NRLN”,and“NRILN”as search terms,the search period was from January 2012 to February 2022.The total incidence,the incidence of right side,Stewart classification,injury rate of NRLN,and the results of NRLN predicted by preoperative imaging were counted.Results One right NRLN,Stewart typeⅠ,was found in our department.The total incidence of NRLN was 0.32%,and the incidence of right NRLN was 0.63%,and there was no intraoperative injury in all cases.Meta-analysis showed that the total incidence of NRLN was 0.46%(95%CI:0.26%-0.66%);the incidence of right side was 0.45%(95%CI:0.22%-0.68%);the incidence of Stewart typeⅠwas 76.47%(95%CI:58.61%-94.33%),and typeⅡwas 23.53%(95%CI:5.67%-41.39%);the injury rate was 10.20%(95%CI:2.93%-17.47%).Imaging prediction showed the presence of an anomalous right subclavian artery in 90%(81/90);the rate of missed diagnosis of NRLN predicted by CT was 19.23%,the misdiagnosis rate of NRLN predicted by chest X-ray was 56.67%,the rate of missed diagnosis of NRLN predicted by ultrasound was 7.25%.Conclusion NRLN is a rare variation with high risk of intraoperative injury,and can be predicted preoperatively by imaging examination,CT and ultrasound scan demonstrate high accuracy.

关 键 词：喉返神经 非返喉神经 甲状腺切除术 血管畸形 

分 类 号：R736.1[医药卫生—肿瘤]