中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2013, Vol. 8 ›› Issue (17): 1568-1575.doi: 10.3969/j.issn.1673-5374.2013.17.004

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

甲状腺术中常规显露喉返神经可预防神经误伤

  

  • 收稿日期:2013-01-13 修回日期:2013-04-20 出版日期:2013-06-15 发布日期:2013-06-15

Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury

Chenling Shen, Mingliang Xiang, Hao Wu, Yan Ma, Li Chen, Lan Cheng   

  1. Department of Otolaryngology & Head and Neck Surgery, Ear Institute, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Received:2013-01-13 Revised:2013-04-20 Online:2013-06-15 Published:2013-06-15
  • About author:Chenling Shen★, Master.

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摘要：

为研究甲状腺手术中常规显露喉返神经防止其损伤的临床价值，实验回顾性分析了5344例甲状腺手术患者的临床资料，其中术中显露喉返神经548例，未显露喉返神经4796例。结果发现显露组喉返神经损伤发生率为2.2%（12/548），明显低于未显露组的10.7%（512/4796）。进一步对病种、术式、术次进行分层比较，发现两组间喉返神经损伤率差异亦有显著性意义，显露组明显低于未显露组。术中显露喉返神经的548例患者中，出现喉返神经解剖变异者128例，发生率为23.4%，但均未发生喉返神经损伤。此外，实验发现以下甲状旁腺和甲状腺中静脉为解剖标志者，喉返神经损伤率明显低于以喉返神经入喉处为解剖标志者。结果提示喉返神经解剖变异较为多见，甲状腺手术中常规显露喉返神经能有效防止其误伤。

关键词: 甲状腺疾病, 神经损伤, 甲状腺切除术, 喉返神经, 显露, 神经解剖, 变异, 下甲状旁腺, 甲状腺中静脉, 神经再生

Abstract:

To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrent laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the inferior parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury.