甲状腺手术中喉返神经显露的临床体会

Clinical experience of exposure recurrent laryngeal nerve of thyroid operation

目的探讨甲状腺手术中喉返神经(RLN)显露的意义及技巧。方法回顾2012年1月至2014年12月安徽医科大学第三附属医院甲乳外科经RLN显露的220例甲状腺手术,手术中显露甲状腺腺叶,切断中静脉及上下级血管,将腺叶牵向内侧,在气管、甲状腺下动脉和颈总动脉所组成的三角深面的气管食管沟内,将纤维疏松组织分数层透明薄膜,直视下清晰无误地层层打开、寻找RLN加以保护,在其内侧将甲状腺腺叶及峡部自气管前分离切除。结果 220例患者中,2例出现暂时性RLN损伤,损伤率为0.90%,无永久性RLN损伤。结论甲状腺手术中解剖、显露RLN,可有效避免RLN损伤。

Objective To explore the significance and techniques of exposure recurrent laryngeal nerve（ RLN） in thyroid operation. Methods The clinical data of 220 patients with thyroid operation that revealed RLN in this hospital from January 2012 to December 2014 were reviewed. After the middle thyroid vein and the upper pole of the thyroid and under pole of the thyroid blood vessels were cut, the ex-posed thyroid gland was pulled to inside in thyroid operation. The fibrous tissue was divided into several layers of transparent thin film in the tracheoesophageal groove, which was under the triangle region that was composed of trachea and inferior thyroid artery and common carotid ar-tery. Then, each layer film was clearly opened under direct vision and find RLN to protect it. Results Two patients had temporary RLN in-jury in all cases, and the damage rate was 0. 90%. No permanent injury of RLN was found in all cases. Conclusion Anatomy and exposure RLN can effectively avoid RLN injury in thyroid surgery.