腔镜甲状腺手术中喉返神经显露与保护策略和经验

Strategy and experience of exposing and protecting recurrent laryngeal nerve in laparoscopic thyroidectomy

目的探讨腔镜甲状腺手术中喉返神经暴露技巧与保护策略。方法回顾性分析广州市白云区中医医院于2011年6月至2015年5月间施行的93例腔镜甲状腺手术病例资料,根据不同诊断分别进行甲状腺大部分切除术、甲状腺次全切除术、甲状腺腺叶切除术加峡部切除术或颈部淋巴结清扫术,术中采用气管食管沟、甲状腺下动脉及甲状软骨下角三个径路暴露喉返神经,总结显露成功率及观察手术并发症。结果本组全部病例均成功显露喉返神经,共计117例次,其中左侧喉返神经32例次,右侧喉返神经37例次,双侧喉返神经合计48例次,其中经气管食管沟径路显露喉返神经57例,占48.71%;经甲状腺下动脉径路显露48例,占41.03%;其余12例经甲状软骨下角径路显露,占10.26%。术后并发喉返神经暂时性麻痹3例,无喉返神经永久性损伤病例。结论腔镜甲状腺手术中显露喉返神经需掌握正确的解剖入路和技巧,遵循主动显露、严格保护的原则。

Objective To summarize the experience for protecting recurrent laryngeal nerve in laparoscopic thyroidectomy. Methods Ninety-three patients under went laparoscopic thyroidectomy in July 2011 to June 2015 and their clinical data were retrospectively analyzed. Basing on different diagnosis, patients were treated with different surgical procedures, including partial thyroidectomy, subtotal thyroidectomy, thyroid gland and isthmic resection or lymph node dissection. During operation, recurrent laryngeal nerve was exposed through tracheoesophageal groove route, and thyroid artery area route and inferior comer of thyroid cartilage route. Results Recurrent laryngeal nerves were successfully exposed in all cases, including 32 nerves of left side, 37 nerves of right side, 48 nerves in both sides. Among of them, 57 cases were exposed through tracheoesophageal groove route （account for 48.71%）,48 were through thyroid artery area route （account for 41.03%）,and 12 were through inferior corner of thyroid cartilage route （account for 10.26% ）. Temporary paralysia of recurrent layngeal occurred in three cases, and no permanent nerve injury was found. Conclusion As long as knowing well correct anatomic approach and skills, following the principle of initiative exposing and strict protection, exposing recurrent laryngeal nerve in laparoscopic thyroidectomy should be feasible and safe.