改良Miccoli术中喉返神经的显露及损伤预防

Identification techniques of the recurrent laryngeal nerve in modified Miccoli style endoscopic thyroidectomy

目的:探讨甲状腺改良Miccoli术中解剖显露喉返神经的方法及预防喉返神经损伤的临床意义。方法:回顾性分析218例行甲状腺改良Miccoli术患者的资料,均在内镜直视下寻找喉返神经并进一步显露直至入喉处,行甲状腺次全切或腺叶全切除。结果:218例患者手术均获成功,无中转开放手术。术中均成功显露颈段喉返神经并保护之。术中、术后病理证实结节性甲状腺肿185例,甲状腺腺瘤8例,甲状腺乳头状微小癌25例。2例甲状腺乳头状微小癌及1例有鼻咽癌放疗史的患者,术后出现暂时性声嘶,3个月内声带活动恢复正常。结论:甲状腺改良Miccoli术中解剖显露喉返神经是该手术顺利进行的关键,是预防喉返神经损伤的有效方法。

Objective：To study the role of anatomizing the recurrent laryngeal nerve（RLN） in preventing the injury in thyroid surgery. Method：A retrospective study of 218 patients performed identification of RLN in modi- fied Miccoli style endoscopic thyroidectomy treated. Under endoscope, all patients underwent sub-total thyroidec- tomy or lobe thyroidectomy, and the RLN of all patients were anatomized to the site of proximal of the larynx. Re- suit： All cases underwent sub-total thyroidectomy except for 25 cases who were diagnosed as papillary thyroid canc- er during surgery, and they were referred to lobe thyroidectomy. Totally 316 RLNs were dissected. Neither tran- sient nor permanent RLN injury occurred in 215 cases. Two cases diagnosed as papillary thyroid cancer and 1 case with radiated therapy for nasopharyngeal cancer suffered hoareness postoperatively, and recoverd 3 months after surgeries. Conclusion： Correct identification of RLN which can prevent injuring RLN which is essential in modified Miccoli style endoscopic thyroidectomy.