甲状腺手术中喉不返神经的解剖特点及处理

Anatomical Character and Management of the Nonrecurrent Laryngeal Nerve during Thyroid Surgery

目的探讨甲状腺外科手术中喉不返神经的解剖特点,总结预防其损伤的处理经验。方法回顾性分析我院2007年12月-2015年1月2 420例甲状腺手术中发现7例喉不返神经患者的临床资料。其中良性甲状腺疾病3例,包括右结节性甲状腺肿伴纤维疤痕形成1例,右甲状腺囊腺瘤1例,双侧结节性甲状腺肿伴右侧囊腺瘤1例;恶性甲状腺疾病4例,包括右甲状腺乳头状癌1例,右甲状腺乳头状癌左甲状腺微小乳头状癌1例,左甲状腺微小乳头状癌2例。结果甲状腺手术中常规显露喉返神经2 802例,共发现喉不返神经7例（0.25%）,均位于右侧,且均为女性患者。7例喉不返神经患者术中均未发生神经损伤。结论喉不返神经临床发生率低,术中仍应警惕,避免其误伤。

Objective To discuss the anatomical character of the nonrecurrent laryngeal nerve（ NRLN）and to summarize the management experience of preventing injury of NRLN during thyroid surgery. Methods The clinical data of 7 patients with nonrecurrent laryngeal nerve among 2 420 cases undergoing thyroid surgery from December 2007 to January 2015 in my hospital were retrospectively analyzed,including 1 case of right lateral nodular goiter combined with scarring,1 case of right lateral thyroid cystadenoma,1 case of bilateral nodular goiter combined with right lateral cystadenoma,1 case of right thyroid papillary carcinoma,1 case of right thyroid papillary carcinoma plus left thyroid papillary microcarcinoma,and 2 cases of left thyroid papillary microcarcinoma. Results Among all 2 420 cases of thyroid surgery,2 802 recurrent laryngeal nerves were exposed routinely,and NLN were found in 7 female cases located in right-sided,and the incidence of NLN was 0. 25%. No nerve injury occurred in the 7 NLN cases. Conclusion The clinical incidence of NLN is low,but it should be pay more attention to avoid injury during thyroid surgery.