甲状腺癌补救性二次手术中喉返神经的显露及保护

The Exposure and Protection of Recurrent Laryngeal Nerve in Remedial Reoperation for Thyroid Cancer

目的探讨甲状腺癌补救性二次手术中喉返神经的显露与保护策略。方法对43例甲状腺癌患者行补救性二次手术。手术从带状肌外侧、胸锁乳突肌前缘入路,在甲状腺残叶背面"未受侵扰区域"或颈段气管食管沟下段的软组织中显露喉返神经,并小心地解剖显露其整个颈段气管旁行程。结果全组共解剖显露喉返神经45条,单侧显露41例,双侧显露2例。二次手术术后暂时性甲状旁腺功能减退1例,无喉返神经损伤病例。结论甲状腺癌补救性二次手术中,避开粘连、瘢痕组织并选择适当的解剖显露途径,熟悉喉返神经正常及变异状况下的解剖均有助于减少喉返神经的损伤。

Objective To investigate the exposure and protection of recurrent laryngeal nerve （RLN） in remedial reoperation for thyroid cancer, Methods Remedial reoperations for thyroid cancer in 43 patients were retrospectively analyzed. Reoperations were approached at the lateral strap muscles and anterior to the stemocleidomastoid muscle. RLNs were exposed either in a previously undissected area at the posterior residual thyroid lobe or in the lower part of the tracheoesophageal groove and were traced very carefully along their cervical course. Results All 43 cases were anatomically exposed RLNs with 41 cases had single exposure and 2 cases had bilateral exposure. There were 1 transient hypoparathyroidism case and 0 definitive recurrent laryngeal nerve palsy case after reoperative surgery. Conclusion In remedial reoperation for thyroid cancer, appropriate anatomic approach should be selected to avoid adhesive or scar tissues, and good knowledge of normal and variant anatomy of RLN can reduce RLN injury.