复发性结节性甲状腺肿再手术中喉返神经的保护探讨

The protection method for recurrent laryngeal nerve in surgery of recurrent nodular goiter patients

目的探索结节性甲状腺肿术后复发再手术中喉返神经的保护策略。方法选取我科32例复发性结节性甲状腺手术患者,回顾性分析其手术、临床资料。结果通过术中精细解剖,清晰暴露甲状腺解剖标志——Berry韧带和Zuckerkandl结节,明确喉返神经"起点"与"终点",完整切除腺体,保护喉返神经完好;术后3例患者出现暂时性声音嘶哑,予以神经营养和理疗,2例患者术后两周内恢复正常,1例患者术后四周内恢复正常。结论结节性甲状腺肿术后复发再手术者,喉返神经毗邻结构因粘连而层次不清,术者掌握必要的手术技巧和精细操作,暴露关键的甲状腺解剖标志以显露喉返神经,是避免其医源性损伤的重要方法 。

Objective To explore the protective method for the recurrent laryngeal nerve in recurrent nodular goiter patients surgery. Methods A retrospective analysis was conducted on 32 patients who underent the second surgery of recurrent nodular goiter. Results By experienced operation, there was a clear sign of Berry ligament and Zukerkandl tubercle in all 32 patients, and the recurrent laryngeal nerve was exposed well enough with this way. Three out of 32 patients were complicated by temporary hoarseness after the surgery and recovered after neurotrophic treatment and physical therapy for less than 4 weeks. Conclusion The second surgery of recurrent nodular goiter patients is challenged by the adhesions of thyroid and its peripheral tissues. Locating the Berry ligament and Zukerkandl tubercle by experienced operative skills is an essential method to protect the recurrent laryngeal nerve from surgical iatrogenic injury.