喉返神经解剖在甲状腺手术中的应用研究

Practical study on anatomization of the recurrent laryngeal nerve during thyroid surgery

目的探讨解剖喉返神经在甲状腺手术中的应用。方法回顾分析因甲状腺疾病行手术治疗的236例患者的临床资料,共施行甲状腺手术335侧次;甲组101例行甲状腺手术158侧次,术中均未解剖喉返神经,其中57例行双侧甲状腺手术。乙组135例行甲状腺手术同时解剖喉返神经177侧次,其中42例因双侧甲状腺手术而行双侧喉返神经解剖。结果喉返神经损伤均发生在切除甲状腺范围包含背侧腺体时。甲组暂时性损伤2例,永久性损伤1例,损伤率为1.9%;乙组暂时性损伤1例,无永久性损伤病例,损伤率为0.56%;两组差异有统计学意义(χ2=0.382,P<0.01)。结论甲状腺手术中解剖喉返神经能减少喉返神经的损伤,切除背侧腺体时应常规解剖喉返神经。

Objective To study the application of anatomization of the recurrent laryngeal nerve in thyroid surgery. Methods The clinical data of 236 patients who had undergone 335 thyroid operations were retrospectively reviewed. They included： One hundred and one patients （Group A ） who had undergone thyroidectomy 158 times without anatomization of the recurrent laryngeal nerve, including 57 of these patients had bilateral thyroid operation; 135 patients （Group B） with anatomization of the recurrent laryngeal nerve who had undergone 177 thyroid operations, including 42 of these patients had bilateral thyroid operations. Results All the 4 nerves injury occurred in the region of removal the posterior aspect of thyroid. Temporary nerve injury occurred in one case （ 0.56 % ） in Group B, and temporary nerve injury and permanent nerve injury occurred respectively in 2 cases and 1 case （ a total injury rate of 1.9 % ） in Group A. There was a significant difference between the two groups（ X^2 = 0. 382, P 〈 0.01 ） .Condusions Recurrent laryngeal nerve injury can be safely reduced by dissection of the nerve during thyroid surgery. The recurrent largngeal nerve should routinely be anatomized during removal of the oosterior asoect of the thyroid gland.