非返性喉返神经的术前诊断及术中损伤的预防

Preoperative prediction and intraoperative injury prevention of nonrecurrent laryngeal nerve

背景与目的:非返性喉返神经是喉返神经罕见的解剖变异,容易导致甲状腺术中喉返神经的损伤。该研究总结非返性喉返神经的术前诊断和术中损伤预防的经验。方法:回顾性分析11例存在非返性喉返神经患者的临床资料,结合文献,探讨非返性喉返神经的术前诊断方法和术中注意事项。结果:术中证实11例均为1型非返性喉返神经,其中7例术前CT提示存在气管食管后锁骨下动脉,1例术中切断后行端端吻合。结论:非返性喉返神经是罕见的解剖变异,术前CT检查可提前判断非返性喉返神经的存在,术中采用精细化被膜操作技术,可减少神经损伤的发生。

Background and purpose： A non-recurrent course is a rare anatomic variation of the recurrent laryngeal nerve, which is highly predisposed to injury in thyroidectomy. The study was to summarize preoperative judgment and injury prevention of non-recurrent laryngeal nerve （NRLN） during thyroidectomy. Methods： Preoperative diagnosis and precautions during thyroidectomy were investigated, clinical data from eleven cases of NRLN were analyzed and related literature was reviewed as well. Results： All eleven cases were NRLN of type 1. Among those, the right subclavian artery was found posteriorly to the trachea and esophagus shown by preoperative CT in seven cases. One case who had NRLN injury underwent nerve anastomosis. Conclusion： NRLN is a rare anatomical variation. Preoperative neck CT scan identifies presence of a NRLN, which may reduce the incidence of nerve injures by using intraoperative capsular dissection.