手术中用以识别喉返神经的几种解剖学标志

在52具(103侧)成人尸体上,对手术中用以识别喉返神经的几种解剖标志进行了观察。作者认为,以甲状软骨下角尖(或环甲关节)、甲状腺悬韧带最可靠;其次为甲状腺下极、甲状腺下动脉和气管食管沟。     

喉返神经的应用解剖研究

目的为甲状腺手术术中对喉返神经的定位和保护提供解剖学基础。方法采用经福尔马林固定的60具成人标本(男40,女20)共120侧,用解剖学方法对喉返神经及其分支进行定位观测,以及观测甲状腺下动脉、甲状软骨下角和甲状腺下极等3种解剖标志与喉返神经的毗邻关系。结果(1)喉返神经的分支有喉支和喉外支,前者在喉前多分为前、后支。(2)喉返神经与甲状腺下动脉的关系分5种类型。(3)91.7%(110侧)喉返神经的喉支多在距甲状腺下角尖端(16.9±7.2)mm处分前、后支,喉外支多在其下(10.4~70.3)mm范围内发出。(4)59.2%的喉返神经分支发出部位在甲状腺下极平面以上,距甲状腺下极平面距离(11.25±7.1)mm。结论在甲状腺手术中应注意喉返神经的变异,通过暴露和辨认喉返神经及其分支防止其损伤。     

手术中对喉返神经定位的应用解剖

目的：为甲状腺手术中对喉返神经的定位和保护提供解剖学基础。方法：在５０具（１００侧）成人标本上，对术中喉返神经易损伤部位进行定位观测。结果：①甲状腺下极区，喉返神经位于气管食管沟内，在气管与颈总动脉之间的浅面平面深度，左侧为１０．４±２．０ｎ１ｍ，右侧为１２．０±２．０ｍｍ；②环甲关节区，喉返神经入喉处距甲壮软骨下角尖为８．２±６ｍｍ，距喉结突出点水平相交点为３３．３±４．３ｍｍ；③腺体侧叶后侧区，９５％的喉返神经在甲状腺外侧韧带后方经过，５％穿甲状腺外侧韧带；④甲状腺下动脉弓形弯曲恒定存在，其最高点至神经与该动脉交叉点的距离为１４．６±４．４ｍｍ。结论：上述喉返神经定位观测结果，是术中防止神经损伤的应用解剖学基础。     

与颈部手术相关的喉返神经的应用解剖

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。     

甲状腺手术中如何保护喉返神经的解剖与临床

甲状腺手术并发症较多,其中喉返神经（RLN）损伤是最严重最令人沮丧的并发症。RLN的损伤率国内外报道不一,为0．3％-17％12。造成RLN损伤的原因多种多样,大多为手术操作不规范和解剖结构不熟悉所致。如何减少并发症尤其是喉返神经损伤的发生呢？充分了解和熟悉与手术相关的应用解剖学和掌握良好的手术技巧是避免并发症发生的关键。1 甲状腺手术区的应用解剖     

喉返神经及其分支与甲状腺下动脉关系的应用解剖

目的为颈部手术中喉返神经及其分支的定位和保护提供形态学基础。方法对47具(男30具,女17具)成人尸体喉返神经和甲状腺下动脉之间的关系进行解剖、观测。结果喉返神经入喉支以2～5支型为多见,占69.15%;喉返神经和甲状腺下动脉之间的关系分为5种类型,左右侧有明显差异(P<0.01)。结论在颈部相关手术中应注意喉返神经的变异,结扎甲状腺下动脉前,应仔细分离、单独结扎该动脉,以免损伤喉返神经及其分支。     

喉返神经的应用解剖

目的为甲状腺手术中误伤喉返神经提供解剖学基础。方法对50具成人尸体的颈前外侧区进行局部解剖,重点观察了喉返神经行程与甲状腺下动脉的关系,分布于喉的分支情况;测量了喉返神经、甲状腺下动脉的直径。结果喉返神经横径为(1.93+0.35)mm。喉返神经入喉支以2～5干型为多见,占70.0%。甲状腺下动脉的直径为(2.61+0.23)mm。喉返神经和甲状腺下动脉之间的关系,左右均有明显差异。喉返神经在甲状腺峡平面分支最为多见。喉返神经位于甲状腺动脉主干之后的有54.0%。结论左、右侧喉返神经与甲状腺动脉位置关系有明显差异,右侧喉返神经多行于动脉之前,左侧喉返神经多行于动脉之后,为临床颈部手术提供了参考。     

喉返神经的应用解剖学

本文解剖115例喉返神经,从临床应用角度出发。对喉返神经的横径,终未分支;喉返神经与甲状软骨下角,甲状腺下动脉,气管食管沟,甲状腺,喉返神经三角的局部关系进行了研究。提出甲状软骨下角,气管食管沟,喉返神经三角是识别喉返神经的简便,可靠、实用的标志和手术中避免损伤喉返神经的解剖学依据。     

喉返神经在颈部的局部解剖及临床应用

目的　为使在甲状腺手术中避免误伤喉返神经提供解剖学基础。方法　对 4 5具 (男 30具 ,女 15具 )成人尸体喉返神经和甲状腺下动脉之间的关系进行解剖、观测。结果　喉返神经平均横径为 1 93± 0 35mm。喉返神经入喉支以 2 - 5干型的为多见 ,占 6 8 9%。甲状腺下动脉的直径为 2 6 1± 0 .2 3mm。喉返神经和甲状腺下动脉之间的关系 ,左右侧有明显差异。结论　喉返神经横径平均在 1 93±0 35mm之间 ;喉返神经在甲状腺峡平面分支的最为普遍 ;神经行于动脉主干之后的有 4 8 9% ,为多见 ;神经行于动脉前及动脉分支间的例数差不多 ,左侧神经行于动脉之后的多见 ,而右侧神经行于动脉之前的多见 ,左右有明显差异 ,在颈部手术时参考     

Arterial supply to the thyroid gland and the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in human fetal cadavers

The aim of this study was to identify the arterial supply to the thyroid gland and the relationship between the inferior thyroid artery (ITA) and the recurrent laryngeal nerve (RLN) in fetal cadavers using anatomical dissection. The anterior necks of 200 fetuses were dissected. The origins of the superior thyroid artery (STA) and the ITA and location of the ITA in relation to the entrance of the thyroid lobe were examined. The relationship between the ITA and the RLN was determined. The origins of the STA were classified as: external carotid artery, common carotid artery (CCA), and the thyrolingual trunk. The origins of the ITA were the thyrocervical trunk and the CCA. The ITA was absent on the left side in two cases. The relationship of the RLN to the ITA fell into seven different types. Type 1: the RLN lay posterior to the artery; right (42.5%), left (65%). Type 2: the RLN lay anterior to the artery; right (40.5%), left (22.5%). Type 3: the RLN lay parallel to the artery; right (11.5%), left (7%). Type 4: the RLN lay between the two branches of the artery; right (1%), left (3.5%). Type 5: The extralaryngeal branch of the RLN was detected before it crossed the ITA; right (4.5%), left (0%). Type 6: the ITA lay between the two branches of the RLN; right (0%), left (0.5%). Type 7: the branches of the RLN lay among the branches of the ITA; right (0%), left (0.5%). The results from this study would be useful in future thyroid surgeries. Clin. Anat. 27:1185–1192, 2014. © 2014 Wiley Periodicals, Inc.     

喉返神经在颈部的应用解剖研究

目的　为在甲状腺手术中避免误伤喉返神经提供解剖学基础。方法　对 5 0具 (男 3 0具 ,女 2 0具 )成人尸体解剖喉返神经和甲状腺下动脉之间的关系进行解剖观测。结果　喉返神经平均横径为 ( 1.93± 0 .3 5 )mm。喉返神经入喉支以 2～ 5干型为多见 ,占 70 .0 0 %。甲状腺下动脉的直径为 ( 2 .61± 0 .2 3 )mm。喉返神经和甲状腺下动脉之间的关系 ,左右均有明显差异。结论　喉返神经横径平均在 ( 1.93± 0 .3 5 )mm之间 ;喉返神经在甲状腺峡平面分支的最为常见 ;神经位于动脉主干之后的为多见 ,占 5 4.0 0 % ;神经位于动脉前及动脉分支之间的例数相近 ,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 ,左右有明显差异 ,为临床颈部外科手术时参考。     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

Abstract: The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.     

喉返神经与非返性喉返神经临床应用解剖学研究进展*

喉返神经变异复杂，其保护是甲状腺手术的难点。喉返神经损伤导致声音嘶哑，严重影响生活质量，也是 医疗纠纷的首要原因之一。非返性喉返神经是喉返神经罕见的解剖变异，是甲状腺手术后声带麻痹的极高危险因 素。现就喉返神经和非返性喉返神经走向与分布以及毗邻，并在甲状腺手术中喉返神经保护的现状及进展的临床 应用解剖研究加以综述。     

喉返神经喉外分支的显微解剖及临床意义

目的探讨甲状腺手术区域喉返神经(RLN)的解剖特点和方法。方法运用大体解剖的方法,对48例成人标本甲状腺手术区域的RLN及其周围毗邻结构进行了观测。结果 48例96侧成人标本中,29%RLN主干穿过环咽肌肌束至致密结缔组织膜下缘,71%RLN主干走行在环咽肌深面。69%RLN在距离甲状软骨下角尖端(15.2±5.5)mm处分为前、后两支,前支多于环状软骨侧方下缘距离甲状软骨下角尖端(5.9±1.8)mm处穿过结缔组织膜,后支入喉点距甲状软骨下角尖端(4.8±2.1)mm;31%RLN未见分支。结缔组织膜下缘RLN与甲状腺下动脉(ITA)分支的关系为:66%(63/96)RLN位于ITA前方,27%(32/96)位于ITA后方。结论大多数RLN具有喉外分支,在以甲状软骨下角作为标志寻找RLN时,要同时找寻RLN及喉外分支的入喉点。ITA与RLN的关系复杂多变,ITA不作为RLN定位的首选。     

Arborization of the inferior laryngeal nerve and internal nerve on the posterior surface of the larynx

The morphological patterns of the inferior laryngeal nerve and internal laryngeal nerve display complex arborizations. This paper attempts to identify and clarify these patterns. Dissections were performed on 105 adult Japanese cadavers, and observations were made on 201 sides. Results showed that the communications between the inferior laryngeal nerve (ILN) and internal laryngeal nerve (ITLN) could be classified into two types and three subtypes. Also, the ITLN displayed three characteristic patterns at the arytenoid cartilage. These communications produce complex arborizations of the ILN as it enters the larynx. This may explain the variety of potential clinical symptoms observed after thyroid surgery or neck dissections. © 1995 WiIey-Liss, Inc.     

Absence of the left inferior thyroid artery: clinical implications

Dissection of an adult male cadaver revealed an absence of the left inferior thyroid artery; its usual area of distribution to the thyroid gland was supplied by the right inferior thyroid artery. Absence of the left inferior thyroid artery occurs in 1-6% of cases. The inferior thyroid artery arises commonly from the thyrocervical trunk, passes posterior to the carotid sheath and supplies the inferior pole of the corresponding lobe of the thyroid gland; its branches can course anterior or posterior to or between branches of the recurrent laryngeal nerve. During thyroid surgery it is imperative to identify the relationship of the inferior thyroid artery to the recurrent laryngeal nerve or to establish its absence because injury to the nerve can be a major complication; awareness of significant variations of the surgical anatomy of the thyroid gland is vital for preserving the integrity of important structures.