甲状腺手术中常规显露喉返神经的安全性分析

Safety of Routine Exposure of Recurrent Laryngeal Nerve in Thyroid Surgery

目的探讨甲状腺手术中常规显露喉返神经的方法及其安全性。方法1458例甲状腺手术中常规显露喉返神经1974侧(其中6例为喉不返神经,均位于右侧),经甲状腺下动脉径路显露1915侧,占97%,经喉返神经入喉处及峡部至气管食管沟径路各显露38侧和21侧,分别占1.9%和1.1%。结果永久性喉返神经损伤7例,占0.5%,暂时性喉返神经损伤24例,占1.6%。结论甲状腺术中常规显露喉返神经是安全的。显露应从甲状腺下动脉附近开始,至神经入喉处全程显露。

Objective To explore the safe approach to routine exposure of the recurrent laryngeal nerve in thyroid surgery. Methods A total of 1974 sides of laryngeal nerves were exposed in 1458 thyroid surgeries, which included six right side non-recurrent laryngeal nerves. Ninety seven percent （1915 sides of the laryngeal nerves） were exposed through inferior thyroid artery way. The rest were exposed through nerve entrance way （38 sides, 1. 9%） or isthmus-to-tracheoesophageal groove way （21 sides, 1.1%）. Results Permanent injury of recurrent laryngeal nerves occurred in seven cases, which comprised 0. 5% of the total surgeries. Transient injury of recurrent laryngeal nerves occurred in 24 cases, which comprised 1. 6% of the total surgeries. Conclusion Routine exposure of recurrent laryngeal nerve in thyroid surgery is safe. The exposure should be started from the inferior thyroid artery and be ended at the nerve entrance into laryngeal.