甲状腺手术解剖喉返神经对其损伤的预防作用

目的：探讨甲状腺手术中解剖喉返神经对预防喉返神经损伤的作用。方法：回顾性分析我科1993年1月～2005年5月手术治疗的甲状腺病变患者517例，解剖喉返神经组（解剖组）163例187侧，未解剖喉返神经组（未解剖组）354例438侧。未解剖组按常规甲状腺手术保护喉返神经行走区的神经。解剖组于甲状腺下极下方离气管食管间沟0～1cm处先找到喉返神经，顺其向上解剖；或先找到喉返神经入喉处，顺其向下解剖。边解剖喉返神经边切除甲状腺病变，解剖长度视甲状腺病变而定。结果：解剖组喉返神经部分解剖123侧，全程解剖64侧，除2例甲状腺癌已侵犯喉返神经术前已有声带麻痹外，无一例发生医源性喉返神经损伤。未解剖组发生喉返神经损伤3例3侧，喉返神经损伤发生率为0．7％，明显高于解剖组，差异有统计学意义（P〈0．01）。结论：甲状腺手术中解剖喉返神经对喉返神经损伤有预防作用。解剖喉返神经的长度视病变大小及部位而定。远离气管食管间沟的良性病变可不解剖喉返神经。

Preventing recurrent laryngeal nerve lesions by anatomizing it during thyroid surgery

OBJECTIVE: To study how to prevent recurrent laryngeal nerve (RLN) lesions by anatomizing it during thyroid surgery. METHOD: In the present study 517 patients with thyroid diseases underwent thyroid surgery from January 1993 to May 2005, with RLNs of 163 cases (187 sides, A group) anatomized and RLNs of 354 cases (438 sides. B group) not anatomized. The RLN in B group were protected generally during thyroid surgery. RLNs of A group were anatomized partly or totally. RESULT: (1) In A group RLNs of 123 cases were partly anatomized and 64 totally. None of all RLNs was injuried. (2) B group 3 sides of 3 cases of all RLNs was injuried. The rate of RLN's lesion is 0.7%, which is significantly higher in A group than in B group. CONCLUSION: Anatomizing RLN during thyroid surgery may prevent its lesions. The length of anatomized RLN must vary with the area and position of thyroid pathological changes. The RLN needn't be anatomized in these patients with the benign thyroid pathological changes which is far away trachea-oesophagus channel.