经锁骨下腔镜甲状腺手术中喉上神经外支探查及临床应用

Dissecting and clinical application of the external branch of the superior laryngeal nerve with endoscopic thyroidectomy via gasless unilateral subclavian approach

目的 探讨经锁骨下腔镜甲状腺技术结合神经探测技术解剖保护喉上神经外支的安全性及可行性。方法 回顾性收集2023年10月到2024年2月期间在浙江大学医学院附属邵逸夫医院头颈外科行经锁骨下腔镜单侧甲状腺切除手术的30例患者的临床资料。结果 30例患者的手术均顺利完成,无中转开放情况。术中共明确显露喉上神经外支29例,喉上神经外支显露率为96.7%;喉上神经外支分离耗时2~6 min、(3.6±2.3)min。术后患者无明显声音低沉、音调改变等喉上神经损伤改变。结论 结合改良锁骨下腔镜甲状腺手术和神经探测技术,可以获得极佳的喉上神经外支的解剖保护效果,安全可行。

Objective To investigate the feasibility of dissecting the external branch of the superior laryngeal nerve using endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring.Methods The clinical data of 30 patients who underwent the gasless nilateral subclavian approach endoscopic thyroidectomy in the Department of Head and Neck Surgery,Sir Run Run Shaw Hospital,Affiliated with the Zhejiang University School of Medicine from October 2023 to February 2024 were retrospectively analyzed.Results All operations were successfully completed under endoscopy approach without transfer to open surgery.A total of 29 cases of the external branch of superior laryngeal nerves were revealed in 30 cases,the revealed rate was 96.7%.The time for dissecting the external branch of the superior laryngeal nerve was 2–6 min[(3.6±2.3)min].There was no obvious sound change related to the injury of the external branch of superior laryngeal nerve in postoperative patients.Conclusion For the modified endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring,excellent anatomical protection of the external branch of the superior laryngeal nerve can be obtained.