甲状腺腺叶切除术中显露喉返神经的意义

The significance of anatomizing the recurrent laryngeal nerve in the thyroid gland lobectomy

目的探讨甲状腺腺叶切除术中解剖显露喉返神经的意义。方法回顾性分析96例甲状腺腺叶切除术患者的资料,全部病例均在全麻或颈丛麻下进行,术中均解剖暴露腺叶切除侧喉返神经。一侧腺叶次全切除20例,双侧次全切除1例,一侧全腺叶切除40例,一侧全腺叶切除加对侧腺叶次全切除6例,一侧全腺叶切除加对侧瘤体切除29例。结果手术过程中共132条喉返神经主干均得到很好的显露,没有出现主干损伤。术后全部96例患者均平稳出院。1例行颈丛麻后即出现声音嘶哑,1例术后出现声音嘶哑,出院时声音嘶哑症状基本消失,术后2个月时完全恢复正常。结论在行甲状腺腺叶次全切和全切除术时,运用多种显露喉返神经的方法相结合,能够有效避免喉返神经的损伤。

Objective To study the significance of dissection and exposure of the recurrent laryngeal nerve（RLN）in thyroid gland surgery.Methods The clinical datas of 96 patients undergone operations on thyroid gland were retrospectively reviewed.All patients had general anesthesia or under the lateral cervical plexus anesthesia,and RLN were exposed during operation.Fourty cases were operated with total lobectomies,20 cases with subtotal thyroidectomy,1case with two side subtotal thyroidectom.6 cases with total lobectomies and subtotal thyroidectomy,29 cases with total lobectomies and contralateral tumor body resection.Results One hundred and thirty-two RLNs were exposed,and there was no trunk damage.All 96 cases of postoperative patients were stable and discharged from hospital.One case came with,one case came with hoarseness postoperatively and recovered after 2 months.Conclusion The thyroid gland line cut and full-leaf sub-total resection,the use of various methods revealed the recurrent laryngeal nerve combination can effectively reduce the recurrent laryngeal nerve damage.