术前颈部血管彩超在预防甲状腺手术中喉不返神经损伤的作用

Effect of Preoperative Carotid Duplex Ultrasound to Prevent Nonrecurrent Laryngeal Nerve Injury During Thyroid Surgery

目的探讨颈部血管彩超对甲状腺手术中喉不返神经术前诊断的临床价值。方法 2010年1月至2014年6月期间四川大学华西医院甲状腺乳腺外科收治甲状腺疾病患者1 931例,对其术前X线胸片检查发现有异常血管影像者常规行颈部血管彩超检查以明确有无右锁骨下动脉畸形。所有患者手术中均采取常规显露喉返神经的方法进行手术。结果 1 931例患者中,术前X线胸片检查发现有异常血管影像者45例(异常组),其颈部血管彩超检查显示17例有右锁骨下动脉畸形,手术中证实该17例患者均存在喉不返神经,术中未发生喉不返神经损伤;另28例右锁骨下动脉显示正常者无喉不返神经病例。术前X线胸片检查正常的1 886例患者中(正常组),手术探查发现4例存在喉不返神经,术中发生喉不返神经损伤1例。该21例患者其喉不返神经均位于右侧,无左侧喉不返神经及喉不返神经和喉返神经共存病例。异常组患者(17例)手术中喉不返神经平均显露时间明显短于正常组〔(4.28±1.08)min比(15.50±2.08)min,t=-15.978,P=0.000〕。结论甲状腺手术前可辅助采用颈部血管彩超检查,若存在右锁骨下动脉畸形,则提示存在右侧喉不返神经,从而可有效避免甲状腺手术中喉不返神经的损伤。

Objective To investigate the clinical value of cervical vascular color Doppler ultrasound for dignosis of nonrecurrent laryngeal nerve before thyroid surgery. Methods There were 1 931 cases of thyroid patients treated between January 2010 to Jule 2014, group these patients according to the results of preoperative chest radiograph examination, the chest radiograph shows abnormal vessels image were group A （45 cases）, no abnormalities were group B （1 886 cases）. Before operaton, made patients of group A to have routine carotid duplex ultrasound to identify whether the right subclavian artery abnormalities. All patients were exposed to conventional methods of recurrent laryngeal nerve during surgery. Results The 45 patients of group A, chest angiography showed 17 cases with right subclavian artery abnormalities, they were confirmed that all the 17 patients were nonrecurrent laryngeal nerve by surgery, no damage cases. The other 28 cases showed a normal right subclavian artery and no cases of nonrecurrent laryngeal nerve. The 1 886 patients in group B, surgical exploration found four cases with nonrecurrent laryngeal nerve, injury in 1 case. The 21 patients whose nonrecurrent laryngeal nerve were on the right side, there were no left side with nonrecurrent laryngeal nerve and no co-exist cases of nonrecurrent and recurrent laryngeal nerve. The average exposure time of nonrecurrent laryngeal nerve in patients of group A （17 cases） was significantly shorter than that group B [ （4.28±1.08） rain vs. （15.50±2.08） min, t=-15.978, P=0.000]. Conclusions The cervical vascular color Doppler ultrasound examination before thyroid surgery can be adjuvant used, if there is the right subclavian artery abnormalities, it showes that there is the right side nonrecurrent laryngeal nerve. So as to effectively prevent the damage of nonrecurrent laryngeal nerve during thyroid surgery.