非返性喉返神经的术前诊断与术中保护

Preoperative prediction and intraoperative protection of nonrecurrent laryngeal nerve

目的总结甲状腺手术术前判定和术中识别及保护非返性喉返神经的经验。方法回顾性分析2009年1月至2012年12月收治的1358例甲状腺手术患者的临床资料，探讨非返性喉返神经的术前判定和术中识别及保护技巧。结果所有患者术前均行颈部增强CT，术中常规暴露喉返神经，其中有4例术前颈部增强CT提示食管后方异常的右锁骨下动脉，术中在正常位置未见喉返神经，均证实为非返性喉返神经，平均手术时间为95min，平均失血量为56ml，术后发音良好，双侧声带活动正常。结论术前颈部增强CT发现食管后方异常右锁骨下动脉，高度提示右侧非返性喉返神经存在，术中仔细操作，有助于避免损伤。

Objective To summarize the experience of preoperative determination, intraoperative identification and protection of nonrecurrent laryngeal nerve （NRLN） during thyroidectomy. Methods The clinical data of 1 358 cases received thyroidectomy from January 2009 to December 2012 were retrospectively analyzed. To explore the preoperative determination, intraoperative identification and protection techniques of NRLN. Results All patients accepted preoperative neck enhanced CT,and recurrent laryngeal nerve was routine exposed at intraoperative. The preoperative neck enhanced CT showed abnormal right subclavian artery in esophagus behind in 4 patients. Intraoperative in normal position did not see laryngeal recurrent nerve, it could be confirmed as NRLN. The mean operative time was 95 min, and the average blood lose was 56 ml. Postoperatively all patients had a good ponunction and the bilateral vocal cords activity was normal. Conclusion Preoperative cervieal enhanced CT find abnormal right subclavian artery in esophagus behind is highly suggestive of the existence of right NRLN, intraoperative careful operation,it＇s helpful to avoid damage.