甲状腺良性肿瘤侧叶切除术中预防喉返神经损伤的探讨

Prevention of the Recurrent Laryngeal Nerve Injury in Excision of Thyroid Neoplasms

目的探讨甲状腺侧叶切除术中喉返神经损伤的原因和预防措施。方法回顾性分析1989～2002年间手术治疗甲状腺良性肿瘤510例的临床资料,全部病例行甲状腺侧叶切除,其中细致解剖40条喉返神经。结果喉返神经损伤11例,损伤率为2.16%,暂时性损伤8例,永久性损伤3例。解剖40条神经发现:喉返神经与甲状腺下动脉关系复杂,多数喉返神经在食管、气管沟行走有偏移或有分支。结论熟悉喉返神经解剖位置及可能变异情况是预防甲状腺手术喉返神经损伤的关键。

Objective To investigate the causes of injury of recurrent laryngeal nerve（RLN） in thyroid surgery and preventive measures. Methods 510 patients with thyroid diseases underwent operation. Among of them, 40 RLNs were dissected. Results RLN injury occured in 11 cases, ratio of injury was 2.16%, 8 cases were temporary injury, and 3 cases were permanent injury. In operation, the positional relationships were complicated. Conclusion The anatomy and variation of RLN must be well-known, and the dissection of RLN in general is an effective method to prevent the injury of RLN in thyroid surgery.