喉返神经显露在胸骨前内镜下甲状腺手术中的应用

Identification of the recurrent laryngeal nerve in endoscopic thyroidectomy via an anterior chest approach

目的:探讨胸骨前内镜下甲状腺手术显露喉返神经(RLN)的可行性。方法:2004年1月至2009年3月共对58例病人行胸骨前内镜下甲状腺手术。行腺瘤切除和甲状腺部分切除术时不显露RLN,而行腺叶或次全切除术则显露RLN。结果:有56例病人在内镜下顺利完成,2例因术中诊断为腺癌而中转开放手术。所有病人均无大出血、RLN损伤、手足麻木等严重并发症发生。结论:恰当地选择病例,掌握胸骨前内镜下甲状腺手术显露RLN时机和RLN显露方法,可减少RLN损伤。

Objective To investigate the feasibility of dissection for recurrent laryngeal nerve（RLN） in endoscopic thyroidectomy via an anterior chest approach. Methods From January 2004 to March 2009, 58 cases underwent endoscopic thyroidectomy for thyroid diseases via an anterior chest approach. RLN was not identified when performing nodulectomy or partial thyroidectomy, while RLN would be identified during lobectomy and near-total thyroidectomy. Results Fifty-six of the 58 cases were completed successfully with endoscopic thyroidectomy and 2 cases were converted to open thyroidectomy because of thyroid carcinoma. No intraoperative or postoperative hemorrhage, RLN injury and numbness of the limb occurred. Conclusions In order to avoid the injury to the RLN, The suitable cases should be selected appropriately, and the indication and methods of indentification of the RLN in endoscopic thyroidectomy would be mastered.