喉返神经分段解剖在腔镜甲状腺切除中的应用

Applied anatomy of recurrent laryngeal nerve segment in endoscopic thyroidectomy

目的：探讨在经乳晕入路腔镜甲状腺切除术中，根据甲状腺切除方式的不同选择喉返神经分段解剖方法来降低喉返神经损伤的价值。方法在47例良性甲状腺疾病患者经乳晕入路腔镜手术中，根据甲状腺切除方式不同分段解剖喉返神经，观察患者术后发声、术中出血量、手术时间、术后手足口周麻木或手足抽搐、术后住院天数等指标。结果所有患者手术均获成功，手术平均时间105（85~195）min，平均出血量25（5~115）ml，平均住院时间4.5（3~7）d，术后均无声音低沉或嘶哑、无饮水呛咳、术后创面无大出血，术后第1天诉双手及口周轻微麻木1例，未经治疗第2天上述症状自行消失。随访3个月~1年均无不适。结论经乳晕腔镜甲状腺良性疾病切除术中，根据甲状腺切除方式不同选择喉返神经分段解剖的方法可降低喉返神经损伤的发生率。

Objective Discuss in trans-areola laparoscopic thyroidectomy,according to different method of thyroidectomy,choose different segment dissection of recurrent laryngeal nerve（RLN）to reduce the possibility damage to the RLN. Methods In all 47 cases of benign thyroid disease that receive trans-areola laparoscopic thyroidectomy,according to different thyroidectomy select different segment dissection of RLN,observe post operation vocality,peri-operation amout of bleeding,length of procedure,post-operation numbness and convulsion of the hands and the feet,post-operation hospital day. Results All 47 patients that receive the operation is successful. Average operation time is 105（85-195）min,average bleeding amout is 25（5-115）ml,average hospital day is 4. 5（3-7）d,no post-operation hoarseness,no drinking cough,no post-operation bleeding,1 case slight hands and mouth numbness in day 1,this symptom disappear in day 2 without treatment. 3 months to 1 year follow-up shows no discomfort. Conclusion In trans-areola laparoscopic thyroidectomy, according to different thyroidectomy select different segment dissection of RLN,can reduce incidence rate of RLN damage.