与颈部手术相关的喉返神经的应用解剖

An applied anatomical study on the recurrent laryngeal nerve and its branches in the region of neck surgery

目的 :为颈部手术中喉返神经的定位和保护提供形态学和局部解剖学基础。方法 :解剖 5 0具 (10 0侧 )成人颈部尸体标本 ,对喉返神经及其分支进行定位观测。结果 :(1)喉返神经的分支有喉支和喉外支 ,前者在入喉前多分为前支、后支。 87%的喉返神经分支呈树枝状 ,13 %的喉返神经分支之间或分支与颈交感干之间相互吻合呈袢状。 (2 )有 2 %的双喉返神经和 1%的非返喉下神经。 (3 ) 94%的喉返神经的喉支多在距甲状腺下角尖端 (16.9± 7.6)mm处分为前、后支 ,喉外支多在其下 10 .4～ 70 .4mm范围内发出。 (4 )喉返神经与甲状腺下动脉的关系分为 5种类型。 (5 )喉返神经与颈部食管及颈动脉鞘的位置关系复杂。结论 :在颈部相关手术中应注意喉返神经的变异 ,通过显露和辨认喉返神经防止其损伤。

Objective: To provide some special information about the morphology and topography of the recurrent laryngeal nerve(RLN) and its branches for the location and protection in neck surgery.Methods: Fifty adult cadaveric specimens(100 sides) fixed with formalin were dissected,analysed and measured. Results: (1) All of the recurrent laryngeal nerve bifurcated into laryngeal branch and extralaryngeal branch,the former usually divided into the anterior branch and posterior branch before entering the larynx.87.0% of the RLNs gave off several branches like a tree;an anastomotic loop connecting one branch of the RLN to another or a twig originated from the cervical sympathetic chain in 13 out of the 100 cases.(2) RLNs existing in both left side and right side appeared in 2 sides;a nonrecurrent inferior laryngeal nerve appeared in 1 case.(3)94.0% of the laryngeal branches originated from the RLN divided into the anterior and posterior branches,the points were about 16.9±7.6 mm away from the inferior horn of thyroid cartilarge;The extralaryngeal branches were originated from the region where under the inferior horn of thyroid cartilage about 10.4～70.4 mm.(4)The relations between RLN and the inferior thyroid artery were divided into 5 types.(5)The relations of the RLN with the neck esophagus and the carotid sheath were complicated.Conclusion:To prevent any inadvertent injury to the RLN the surgeon must be aware of the different pattern of the RLN,identify them and keep them in sight.