颈部Berry韧带区的外科解剖

Surgical anatomy of the region of Berry ligament in neck

目的通过对甲状腺手术中最常发生喉返神经损伤的Berry韧带区的解剖,为甲状腺手术中避免喉返神经的损伤提供解剖学基础。方法对25例(男性15例,女性10例)固定尸体标本进行大体解剖,记录Berry韧带的起止点及其与喉返神经的位置关系。将甲状腺分别向外侧、前内侧提拉,从甲状腺的内、外侧测量喉返神经距Berry韧带甲状腺缘的距离。测量甲状腺下动脉主干上方喉返神经相对其入喉点的走形角度。结果 Berry韧带为一致密的白色致密结缔组织带,自环状软骨的中下缘外侧向下延伸到甲状腺峡部的水平,占2～3个气管软骨环,连接气管的后外侧与甲状腺。将甲状腺向前内侧、外侧提拉,测得喉返神经距Berry韧带甲状腺缘的距离分别为(4.8±1.5)和(2.7±0.9)mm。喉返神经主干走形在Berry韧带的后外侧,其分支均在Berry韧带的后方或中间穿过上行。有14侧喉返神经与其入喉点成0°～15°角走行,36侧成15°～30°角上行入喉。结论熟悉掌握Berry韧带区的解剖结构,对甲状腺手术中识别和避免喉返神经的损伤有重要意义。

Objective Avoiding recurrent laryngeal nerve injury is aided by a precise anatomical understanding of the region of Berry ligament before entry into the larynx where it is at greatest risk during thyroidectomy.Methods Twenty-five embalmed specimens（fifteen males,ten females） were dissected for completed anatomical information in the region of the ligament of Berry.The position of the Berry ligament and the relationship between recurrent laryngeal nerve and the ligament of Berry were noted with the high-resolution photographs.The distance from the recurrent laryngeal nerve to the thyroid side of Berry ligament was measured respectively when rotation post-laterally or antero-medially.The angle of the recurrent laryngeal nerve using the entry point into the larynx as the base line was described above the inferior thyroid artery.Results The ligament of Berry connected the tracheal to the thyroid and was identified as a whitish connective tissue band.Berry ligament extended from the mid-lower part of cricoid cartilage to the second or,at times,to the third tracheal ring,about at the level of thyroid isthmus.The distance between the recurrent laryngeal nerve and the thyroid side of Berry ligament were（4.8±1.5） and（2.7±0.9） mm when rotation post-laterally or antero-medially respectivly.The trunk of the laryngeal nerve all passed lateral to the ligament of Berry in all cases,and the branches passed laterally or through the ligament of Berry.The angle of the recurrent laryngeal nerve related to the tracheoesophageal groove were 0°-15° for fourteen sides,15°-30°for thirty-six sides.Conclusion Precise anatomical understanding of the region of Berry ligament is essential to identify the recurrent laryngeal nerve and to protect the injury of the recurrent laryngeal nerve during thyroidectomy.