非返性喉返神经的临床所见及文献回顾

Clinical findings and literature review of non-recurrent laryngeal nerve

目的探讨非返性喉返神经(non recurrent laryngeal nerve,NRLN)的变异规律及保护的方法。方法对我院近3年来的4例NRLN病例总结及对国内学者1995年至今报道的NRLN病例进行回顾性分析。结果 NRLN的临床平均发生率为0.35%,以右侧居多(96.36%),均伴有右侧锁骨下动脉解剖变异;NRLN的损伤率高达11.82%,自2007年以来NRLN的损伤率显著降低(5.20%);NRLN的变异类型以II型为主,其中IIA型多于IIB型。结论 NRLN是一少见变异、同时伴有高损伤率,但是通过规范的神经解剖、辅助检查及术中神经检测可以有效发现并避免神经损伤。

OBJECTIVE To investigate the anatomical characteristics and variation of non-recurrent laryngeal nerve （NRLN） and to explore the method to protect this nerve during thyroidectomy. METHODS Four patients with NRLN who underwent thyroidectomy from Feb. 2010 toFeb. 2013 in Beijing Chaoyang Hospital Captial Medical University were analyzed retrospectively.The literature related NRLN were reported by Chinese scholars since 1995 also were reviewed. RESULTS The incidence of NRLN is about 0.35% in thyroidectomy surgery. The most of this variation happened on the right side and associated with a right subclavian artery anomaly. The most variation of NRLN is belong to type II. Among them, variation of type IIA is more than type IIB. NRLN is a rare anomaly, and injury rates up to 11.82% during thyroid surgery. However Since 2007, the injury rate （5.20%） of NRLN was decreased significantly. CONCLUSION NRLN is a rare anatomical variant, accompanied by a high injury rate, but through standardized neuroanatomy, auxiliary examination and intraoperative neuromonitoring can effectively detect and prevent nerve damage.