摘要
目的:探讨甲状腺手术中解剖喉返神经的意义及预防喉返神经损伤的方法。方法:回顾性分析230例行甲状腺手术患者的资料,所有患者均在全身麻醉下进行,行单侧腺叶切除术109例,单侧腺叶加峡部切除术59例,甲状腺次全切除术44例,甲状腺全切除术18例。术中常规解剖显露喉返神经;根据术中病变情况决定手术切除范围,手术前后分别进行喉镜观察声带活动情况。结果:解剖暴露喉返神经共292条(右侧156条,左侧136条);位于气管食管沟内走行者134条,偏离者158条;神经位于下动脉深面通过197例(67.5%),神经位于动脉浅面通过60例(20.5%),神经在动脉分支之间通过24例(8.2%),神经分支与动脉分支交叉穿过者11例(3.8%)。喉返神经入喉前分支者185条(63.4%),未分支直接入喉者107条(36.6%)。术后8例出现声音嘶哑,经过治疗7例恢复,1例经6个月后对侧声带超越代偿嘶哑改善,无永久性声音嘶哑和呼吸困难。结论:甲状腺手术中解剖喉返神经是防止术后喉返神经损伤的有效方法。
Objective：To explore the advantage of exposure recurrent laryngeal nerve （RLN） in thyroid surgery and to detect the methods of avoiding nerve damage. Method： Two hundred and thirty thyroidectomy eases were studied from June 2003 to May 2006 retrospectively. One hundred and nine eases were operated with total lobectomies, 59 cases withlobectomies and gorge gland, 44 cases with subtotal thyroidectomy, 18 cases with total thyroidectomy. RI.N were exposed during operation and vocal cord were supervised before and after surgery by laryngoscope. Result：Two hundred and ninty two RLNs were exposed including 156 of right and 136 of left, and 134 nerves gone along the traeheoesophageal groove and 158 deviated it. One hundred and ninty-seven （67.5 %） gone under the artery and 60 up （20.5%）, 24（8.2%） through two artery branches, and the nerve branch across the artery branch were 11 （3. 8%）. One hundred and eighty-five （63. 4%） RLNs had branches into laryngeal, 107（36.6%） RLNs had no branches. Eight cases came with hoarseness postoperatively, seven cases recovered, one improved for the other vocal cord surpassed compensation after 6 months. Conclusion.. Anatomizing the recurrent laryngeal nerve in the thyroideetomy was available and could protect RLN.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2008年第12期544-546,550,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
甲状腺
喉返神经
解剖
Thyroid gland
Recurrent laryngeal nerve
Anatomize
