摘要
目的探讨甲状腺术中喉返神经的解剖及显露的临床意义,以减少喉返神经损伤。方法回顾性分析965例甲状腺手术患者的临床资料,所有手术均在全痳下进行并常规显露喉返神经,手术切除范围由病变情况决定,并对喉返神经解剖特点、损伤情况进行分析。结果共解剖显露喉返神经1052条,其中右侧721条,左侧331条,包括双侧87条;采用上方入路解剖86条,侧方661条,下方305条;右侧喉返神经位于气管食管沟内走行者461条,偏离者260条;左侧位于气管食管沟内走行者285条,偏离者46条;喉返神经入喉前有分支者687条(65.3%),未分支直接入喉者365条(34.7%);喉不返神经2条;解剖神经平均用时(6.7±0.54)min;术后神经暂时性损伤11例,永久性损伤2例,均于6个月后对侧声带代偿,嘶哑改善。结论熟悉喉返神经的解剖,灵活运用不同的解剖入路,常规解剖显露神经,是避免喉返神经损伤的有效方法。
Objective To study the anatomic feature and exposing methods of recurrent laryngeal nerve（RLN） in thyroid surgery and to reduce the RLN injury. Methods The data of nine hundred and sixty-five cases were analyzed retrospectively, who were operated with total lobectomies. All RLNs were anatomically exposed, the resection part was chosen for the diseases＇ feature, and the anatomic feature and injury of RLN were discussed. Results One thousand and fifty-two RLNs were exposed, including 721 nerves of right side and 331 nerves of left side, 87 nerves in both sides. 86 nerves were by superior exposure, 661 by lateral exposure, and 305 nerves by inferior exposure. Among all nerves, 461 went along the tracheoesophagea] groove and 260 nerves deviated it in right, 285 went along it and 46 nerves deviated it in left, 687 RLNs （65.3%） had branches into laryngeal, 365 RLNs （34.7%） had no branches, and two non-recurrent laryngeal nerves were found in these cases. It took （6.7 _＋ 0.54） minutes on average to reveal nerves. Eleven cases had temporary postoperative nerve injuries, 2 had permanent nerve injuries, and all cases improved for the other vocal cord surpassed compensation after 6 months. Conclusion To realize the anatomic feature of RLN, to use the different routes to reveal the RLN and to expose every RLN are very useful for avoiding the injury of RLN.
出处
《中华普通外科学文献（电子版）》
2014年第1期20-22,共3页
Chinese Archives of General Surgery(Electronic Edition)
关键词
甲状腺切除术
解剖
喉返神经
Thyroidectomy
Anatomy
Recurrent laryngeal nerve
