喉返神经及其分支的应用解剖及临床意义

目的为颈部手术中喉返神经的定位和保护提供解剖学基础。方法解剖30具（60侧）成人颈部尸体标本，对喉返神经及其分支进行定位观测，并使用统计软件对数据进行处理。结果（1）喉返神经横径为（1．92±0．35）mm。（2）喉返神经行于气管食管沟内，但也有少部分离开一定距离斜行人沟内，尤以右侧常见。（3）87．0％喉返神经分支形态呈树枝状；13．0％喉返神经分支与分支或分支与交感神经间吻合成袢状。（4）喉返神经在喉外一般有2-5条分支，以3、4支型多见，占71．7％。（5）93．3％喉返神经的喉支在距甲状软骨下角尖端（16．5±7．2）mm处分为前、后支，喉外支多在其下10．5～70．2mm范围内发出。前、后支可在甲状软骨下角尖端的前下、后下和直接下方入喉。（6）61．7％喉返神经分支发出部位在甲状腺下极平面以上，距甲状腺下极（10．2±7．1）mm；4．0％分支发出部位与甲状腺下极相平齐；31．7％在其平面以下，与之距离为（8．5±5．6）mm。（7）喉返神经位于甲状腺下动脉主干之后者为多见，占46．7％；但左右有明显差异，左侧神经位于动脉之后的多见，而右侧神经位于动脉之前的多见。结论在颈部手术中应注意喉返神经的各种变异，通过显露和辨认喉返神经防止其损伤。

Applied Anatomy and Clinical Significance of Recurrent Laryngeal Nerve and Its Branches

Objective To provide the anatomical bases in order to locate and protect laryngeal nerve in the operation of neck.Methods Dissecting 30 cervical part of corpses ,then,locating and observing laryngeal nerve and its branch through fineness dissecting. Then deal with the data with statistics software. Results （1）The TD of laryngeal nerve was（1.92 ±0.35）mm. （2）Laryngeal nerve lines on trachea esophagus groove, but a few part goes into the groove obliquely, especially the right side. （3）87 percent of laryngeal nerve branches like twig;13 percent laryngeal nerve branches anastomose or branches and adrenergic nerve anastomose with each other. （4） Laryngeal nerve had 2- 5 branches, 3 -4 branches account to 71.7 percent. （5）93.3 percent larynx branches of laryngeal nerve separate into ahead and posterior branches, （16.5±7.2）mm far away from cornu inferius cartilaginis thyroideae. Larynx extermal branch lines 10.5 ± 70.2mm far from it. Ahead branch and posterior branch afferens into larynx from cornu inferius cartilaginis thyroideae. （6）61.7 percent of erupt position of laryngeal nerve branches were above glandula thyreoidea anus perineum plane, （10.2 ± 7.1）mm far from glandula thyreoidea anus perineum. 4 percent erupt position of branches were at the same hight of glandula thyreoidea anus perineum. 31.7 percent were blow the plane, （8.5 ± 5.6）mm far from it. （7）The number of laryngeal nerve which mostly locate post glandula thyreoidea infer-arteries bole was large,account 46.7 percent. But,the left and right was obviously different,the number witch left nerve locates post of artery was large,while,the right nerve locate before the artery was normally. Conclusion To prevent any inadvertent injury to the RLN the surgeon must be aware of the various variation of the RLN, identify them and keep them in sight.