甲状腺手术中喉不返神经的手术操作技巧

The importance of nonrecurrent laryngeal nerve in thyroid surgery

目的了解喉不返神经解剖特点和变异,总结甲状腺手术中发现喉不返神经的方法和预防损伤的经验。方法分析5例甲状腺手术中发现的喉不返神经患者的临床资料,分析喉不返神经手术操作技巧。结果经手术证实本组5例喉不返神经均位于右侧,术中有3例切断了喉不返神经,2例出现了声音嘶哑,1例神经吻合后声音无明显变化。结论甲状腺手术中在颈动脉鞘和喉之间,除外甲状腺中静脉之外的任何横行索状结构均不能首先切断,需显露喉返神经后再作处理;甲状腺手术中如探查喉返神经缺如,均需显露颈段迷走神经,以寻找是否存在喉不返神经。

Objective To investigate the anatomic variation of nonrecurrent laryngeal nerve （NRLN） and its surgical identification and prevention during thyroidectomy. Methods The database of 5 NRLN eases was analyzed to investigate the difference of operative maneuvers and procedures. Results All 5 NRLN were located in the right side. Two cases were found have vocal cord paralysis and 1 ease recovered in 3 cases who have NRLN injures. Condusions Any transverse bond should not be cut between vascular and laryngeal except middle thyroid vein, Recurrent laryngeal nerve （RLN） should be dissected during thyroid excision. Cervical pneumogastric nerve should be systematic dissected to detect whether RNLN is exist, if RLN is not exist in the same side.