甲状腺良性病变术中损伤喉返神经的原因及预防(附2266例分析)

The reason and the prevention of recurrent laryngeal nerve injury during operation on benign thyroid neoplasm

目的探讨甲状腺良性病变手术所致喉返神经(RLN)损伤的原因及预防措施。方法回顾分析2000年1月至2004年7月2266例甲状腺良性病变的手术资料,对甲状腺良性病变的位置及手术方法与RLN损伤的关系进行比较分析。结果位于甲状腺背侧的良性病变RLN损伤率为8.62%(81/940),显著高于甲状腺其他部位病变的手术损伤率(0.15%)。位于甲状腺背侧的结节性甲状腺肿、甲状腺腺瘤,显露RLN组的喉返神经损伤率为1.56%(1/64)、0(0/33),显著低于未显露喉返神经的损伤率[8.53%(59/692)、13.91%(21/151)]。位于甲状腺其他部位的良性病变,显露RLN组与未显露喉返神经组的RLN损伤率差异无显著性。结论甲状腺良性病变手术,喉返神经损伤与病变位置有关;结节性甲状腺肿、甲状腺腺瘤位于甲状腺背侧,手术应常规显露RLN,而位于其他部位则不需常规显露RLN,可采用RLN区域保护法。

Objective To investigate the reason and the preventive measures of recurrent laryngeal nerve injury during operation in patients with benign thyroid neoplasm. Methods The clinic data of 2 266 cases of benign thyroid neoplasm admitted between Jannary 2000 and July 2004 were analyzed retrospectrvely. The relationships between different neoplasm location and different operation measure in injury of recurrent laryngeal nerve were studied. Results Injury incidence of recurrent laryngeal nerve in the cases with neoplasm located on the background of thyroid was 8. 62% （81/940）, which was significantly higher than that in the cases with neoplasm on other sites （0. 15%,2/1303）. In the cases with nodular goiter and thyroid adenoma on the dorsum of thyroid, injury incidence of recurrent laryngeal nerve were 1.56 % （1/64） and 0 （0/33） ,respectively,for exposed cases and 8.53% （59/692） and 13.91% （21/151） ,respectively,for non-ex- posed. In the cases with benign thyroid neoplasm on the other sites of thyroid, injury incidence of recurrent laryngeal nerve was not significantly different between exposed and non-exposed cases. Conclusion The location of neoplasm is one of reasons of injury of recurrent laryngeal nerve. Exposing the recurrent laryngeal nerve is necessary in the cases with nodular goiter or thyroid adenoma on the dorsum of thyroid.