喉返神经三分段在甲状腺被膜解剖技术中的应用

目的 探讨在甲状腺被膜解剖术中,采用喉返神经(recurrent laryngeal nerve,RLN)三分段的方法对降低RLN损伤的意义.方法 112例良性甲状腺疾病患者采用被膜解剖技术施行单侧腺叶切除术,经中间入路,在RLN三分段的不同部位采用相应的方法进行解剖操作.结果 112例单侧甲状腺腺叶切除后检查甲状腺后方假被膜完整109例(97.3％),在Bery韧带平面透过甲状腺后方假被膜可见到RLN走行91例(81.2％),无神经裸露病例,术后无1例声音嘶哑,随访3个月无声音改变病例.结论 良性甲状腺疾病患者采用被膜解剖技术行腺叶切除,术者对RLN三分段的认识有助于降低神经损伤的风险.

Three-segmented recurrent laryngeal nerve in capsular dissection of thyroid gland

OBJECTIVE To investigate the significance of three-segmented recurrent laryngeal nerve（RLN）in reducing the risk of RLN injuries in the capsular dissection of thyroid gland.METHODS The surgeries were performed in 112 cases of unilateral thyroid lobectomy for patients with benign thyroid diseases.During the procedure,midline approach and capsular dissection were used,and different technique for dissecting thyroid gland were adapted according to the relationship between RLN and ligament of berry.RESULTS False capsule behind the thyroid were found intact in 109 cases（97.3%）after unilateral lobectomy,the RLN were visible posterior and lateral to Berry ligament in 91 cases（81.2%）.There were no cases of nerve exposure during operation,no case of hoarseness,and no cases of changed voice in the 3 months follow-up.CONCLUSION In the thyroid lobectomy for patients with benign disease,understanding of the three segments of RLN is benefit for surgeon to reduce the risk of RLN injuries.