甲状腺肿瘤手术喉返神经损伤的预防

目的：探讨甲状腺手术中喉返神经损伤的原因及预防措施。方法：手术治疗甲状腺疾病125例，术中显露喉返神经，行甲状腺腺叶或腺叶＋峡部切除术治疗原发灶。结果：共解剖喉返神经145侧，术后出现暂时性喉返神经损伤1例。喉返神经损伤发生率为0．8％（1／125）。结论：熟悉喉返神经的解剖及变异，术中显露喉返神经，行瘤侧腺叶或腺叶＋峡部切除术，能避免损伤喉返神经，是甲状腺肿瘤手术预防喉返神经损伤的有效方法。     

甲状腺肿瘤手术中解剖喉返神经的意义

背景与目的：目前临床对甲状腺肿瘤手术是否常规显露喉返神经仍存在争议，我们探讨术中解剖喉返神经的方法及其利弊。方法：对手术治疗的甲状腺肿瘤患者456例进行回顾性分析，266例手术常规显露喉返神经，190例手术常规不显露喉返神经，采用解剖区域保护法行甲状腺次全切除术。结果：解剖喉返神经术式组无喉返神经损伤，不显露喉返神经术式者喉返神经损伤4例（暂时性喉返神经损伤3例，永久性喉返神经损伤1例）占2．1％。暂时性喉返神经损伤3例，其中1例因一侧肿瘤较大，2例因结节性甲状腺肿位于甲状腺后背侧造成损伤，永久性喉返神经损伤1例为肿瘤复发再次手术。结论：熟悉喉返神经的解剖和变异，行甲状腺切除术时解剖显露喉返神经可以降低喉返神经损伤的发生率。     

甲状腺肿瘤手术中喉返神经损伤的预防

目的 :探讨甲状腺手术中喉返神经损伤的原因及预防措施。方法 :手术治疗甲状腺疾病 12 5例 ,术中显露喉返神经 ,行甲状腺腺叶或腺叶 峡部切除术治疗原发灶。结果 :共解剖喉返神经 14 5侧 ,术后出现暂时性喉返神经损伤 1例 ,喉返神经损伤发生率为 0 8% (1/12 5 )。结论 :熟悉喉返神经的解剖及变异 ,术中显露喉返神经 ,行瘤侧腺叶或腺叶 峡部切除术 ,能避免损伤喉返神经 ,是甲状腺肿瘤手术中预防喉返神经损伤的有效方法     

喉返神经显露在甲状腺手术中的应用

[目的]探讨喉返神经显露对减少甲状腺手术中喉返神经损伤的作用。[方法]随机将行甲状腺一侧或双侧腺叶全切术患者分成显露喉返神经组和不显露喉返神经组 ,并对其结果进行比较。[结果]显露组697例共显露喉返神经723条 ,术中致喉返神经暂时性损伤10例 ,永久性损伤4例 ,其中3例为喉返神经被癌组织侵范而一并切除 ;不显露组311例 ,术中致喉返神经暂时性损伤11例 ,永久性损伤12例 ,其差异具统计学意义(P<0 01)。[结论]在行一侧或双侧甲状腺腺叶全切除术中 ,常规显露喉返神经能明显减少喉返神经的损伤率。但对仅作甲状腺腺叶次切或遇巨大甲状腺肿瘤的手术时应按具体情况分别对待。     

喉返神经显露在甲状腺手术中的应用

「目的」探讨喉返神经显露对减少状腺手术中喉返神经损伤的作用。「方法」随机将行甲状腺一侧或双侧腺叶全切术患者分成显露喉返神经组和不显露喉返神经组,并对其结果进行比较。「结果」显露组６９７例共显露喉返神经７２３条,术中致喉返神经暂性损伤１０例,永久性损伤４例,其中３例为喉返神经被癌组织侵范而一并切除;不显露组３１１例,术中致喉返神经暂性损伤１１例,永久性损伤１２例,其差异具统计学意义（Ｐ〈０．０１）。     

甲状腺肿瘤手术中喉返神经损伤的预防及处理

目的：探讨术中喉返神经医源性损伤的预防。方法：对我院1986年3月至2000年12月收治的1091例甲状腺肿瘤手术病例进行总结分析。结果：喉返神经损伤的发生率为2．9％，其中永久性喉返神经麻痹发生率为1％，其中以恶性肿瘤占多数（78％），特别是在外院已行甲状腺肿瘤切除或剜除术的甲状腺癌发生率高。结论：甲状腺肿瘤手术中预防喉返神经损伤，术后辅以神经营养药对症治疗，将有助于神经功能的恢复。     

两种喉返神经显露技术预防术中损伤的疗效比较

[目的]探讨预防喉返神经损伤的手术操作技巧.[方法]对790例甲状腺腺叶切除术患者进行回顾性研究,并对两种喉返神经显露技术预防术中损伤的疗效进行比较.[结果]神经表面解剖组304例,解剖神经312条,术后暂时性损伤6例,占1.98%,永久性损伤3例,占0.99%;神经内侧解剖组486例,解剖神经508条,暂时性损伤3例,占0.62%,无永久性损伤.两组差异具有统计学意义(P＜0.05).[结论]在甲状腺腺叶切除术中,神经内侧解剖较神经表面解剖能更有效地预防喉返神经损伤.     

喉返神经解剖在甲状腺手术中的意义

目的探讨喉返神经解剖在甲状腺手术中的意义及在预防喉返神经损伤中的作用。方法分析125例甲状腺手术常规行喉返神经解剖;55例按传统方法仅行肿块切除而不解剖喉返神经。结果125例甲状腺手术常规行喉返神经解剖中,喉返神经损伤2例,无永久性损伤;55例按传统方法仅行肿块切除而不解剖喉返神经中,喉返神经损伤5例,永久性损伤2例。结论建议甲状腺手术应常规行喉返神经解剖,能减少喉返神经的损伤。     

甲状腺肿瘤手术中喉返神经损伤的预防及处理

目的　探讨术中喉返神经医源性损伤的预防。方法　对我院 1986年 3月至 2 0 0 0年 12月收治的 10 91例甲状腺肿瘤手术病例进行总结分析。结果　喉返神经损伤的发生率为 2 9% ,其中永久性喉返神经麻痹发生率为 1%。其中以恶性肿瘤占多数 ( 78% ) ,特别是在外院已行甲状腺肿瘤切除或剜除术的甲状腺癌发生率高。结论　甲状腺肿瘤手术中预防喉返神经损伤 ,术后辅以神经营养药对症治疗 ,将有助于神经功能的恢复。     

甲状腺腺叶切除的手术探讨

目的　探讨甲状腺腺叶切除的合理手术方法。方法　对 3 10例甲状腺单发结节行一侧腺叶切除术后进行临床分析。结果　本组仅 3例出现了喉上神经损伤 ,绝大多数病例均获得了良好的手术效果。结论　施行甲状腺腺叶切除术时要熟练掌握颈部的局部解剖 ,术中常规显露患侧喉返神经 ,完整地切除患侧腺叶 ,如此可最大限度地减低手术并发症 ,减少肿瘤局部复发。     

腔镜辅助甲状腺切除术中喉返神经的显露及保护

 目的　探讨腔镜辅助甲状腺切除术（MIVAT）中定位喉返神经的解剖标志及避免神经损伤的操作技巧。方法　2008年8月至2010年8月 开展 MIVAT 106例,其中8例中转为开放手术。术中以"气管、颈动脉间隙"结合"气管外侧壁中、后份"作为解剖标志定位喉返神经。结果　术中共需探测喉返神经98条,其中97条（98.98 %）喉返神经通过上述解剖标志顺利探查到,未探查到的1例为右侧非返性喉返神经;1例（1.02 %）术后出现一过性喉返神经麻痹,无永久性喉返神经麻痹发生。结论　MIVAT术中,"气管、颈动脉间隙"结合"气管外侧壁中、后份"是安全有效的喉返神经解剖定位标志     

Laryngeal nerve morbidity in 1.273 central node dissections for thyroid cancer

Aim

We assess the prevalence and mechanism of recurrent laryngeal nerve (RLN) injury in central neck dissection (CND) for thyroid cancer.

甲状腺全切治疗分化型甲状腺癌的临床意义和并发症分析

目的：探讨甲状腺全切除术治疗分化型甲状腺癌的临床意义及相关风险.方法：对2007年1月至2011年6月我院行甲状腺全切术及甲状腺次全切或近全切患者的临床资料进行回顾性分析,92例患者实施甲状腺全切手术为全切组;86例患者实施次全切或近全切术为双叶组,20例患者复发后二次手术行全切术为复发组,分析患者术后甲状旁腺功能和喉返神经损伤情况.结果：甲状腺全切组术后甲状旁腺功能减退发生率明显高于双叶组（P＜0.05）,而复发组则明显高于全切组（P＜0.05）;甲状腺全切组术后喉返神经损伤发生率则与另外两组无显著性差异（P＞0.05）.全切组中有腺体外侵犯组的甲状旁腺功能减退及喉返神经损伤发生率明显高于无腺体外侵犯组（P＜0.05）,而根治性颈清组并发症发生率与中央区颈清组无显著统计学差异（P＞0.05）.结论：甲状腺全切除术增加甲状旁腺功能减退发生率,而不增加喉返神经损伤的发生率;复发二次手术会增加甲状旁腺功能减退的发生,对喉返神经损伤的发生无显著影响;存在腺体外侵是增加并发症的危险因素,而是否行根治性颈清术不增加并发症的发生.因此在临床工作中应该有选择的施行甲状腺全切除手术.     

喉返神经显露技术在甲状腺癌手术中的应用

目的：探讨喉返神经显露技术在甲状腺癌手术中应用的意义。方法：对2009年8月至2012年8月本科收治的甲状腺癌患者112例,术中常规探查双侧喉返神经后行甲状腺全切术并行患侧Ⅵ区淋巴结廓清术,探讨手术治疗效果及防止喉返神经损伤的方法。结果：所有患者均成功探查双侧喉返神经,共224条,甲状腺腺体及癌肿包块完整切除。术后7例出现单侧声带活动障碍,5例患者1年内恢复正常,2例未恢复正常,无肿瘤复发病例。结论：甲状腺癌术中探查喉返神经有助于腺体及癌肿的完整切除,是防止术后喉返神经麻痹的有效方法,对保证患者术后生活质量具有重要意义。     

Complications of Completion Versus Total Thyroidectomy

Introduction : The objective of this study was to analyze the complication rates after completion thyroidectomyand compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. Patientsand Methods: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiatedthyroiud cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 giventotal thyroidectomy for benign diseases (Group 3). Results: When groups were compared for complications,there were no significant difference except temporary hypocalcemia between completion thyroidectomy andtotal thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were nosignificant difference observed except unilateral temporary RLN palsy. Conclusion: With improvements insurgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseasesare reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidismare the main complications in completion thyroidectomies which need special attention. To evaluate the patientsmore carefully in preoperative period and performing adequate thyroidectomy appears more logical.     

Identification and monitoring of the recurrent laryngeal nerve during thyroidectomy

Careful dissection of the recurrent laryngeal nerve (RLN) represents perhaps the most critical component of thyroidectomy. It long has been established that routine identification of the nerve reduces the risk of iatrogenic injury. In recent years, much attention has been paid to the role that functional monitoring plays in identification and preservation of the RLN. This article explores methods for detecting and identifying the RLN. It then examines the evolution of functional RLN monitoring, its potential advantages and disadvantages, statistical validity, and its role in the current medicolegal climate.     

Clinical Significance of Recurrent Laryngeal Nerve Exposure During Esophagogastric Anastomosis of the Neck

OBJECTIVE To investigate the clinical value in a comparison between intraoperative exposure and non-exposure of the recurrent laryngeal nerve (RLN) of the neck during left neck esophagogastric anastomosis following resection of carcinomas of the middle and inferior-segment esophagus. METHODS From January 2003 to April 2009, 237 patients were selected to undergo resection of esophageal squamous carcinoma via posteroexternal incision of the left chest plus gastroesophageal anastomosis at the left neck incision. The 237 cases were divided into 2 groups: 115 of the total cases were in group A (the study group), cases of resections with neck RLN exposure. Of the patients in this group, 64 were male and 51 female, with a mean age of 49 ranging from 31 to 73 years. Another 122 cases were in group B (the control group), cases of resections without neck RLN exposure. In this group, 51 of the patients were male and 71 female, with a mean age of 45 ranging from 33 to 75 years. In the 2 groups, there were 9 cases in total with symptoms induced by RLN injury. RESULTS Hoarseness, choking cough when drinking, and difficult expectoration were found in 1 of the cases (1/115) in group A (0.087%), while there were 8 cases (8/122) presenting with these symptoms in group B (6.5%). There is statistical signi.cance in the di.erences of RLN injury between the 2 groups (P < 0.05). CONCLUSION Analysis of study cases of esophageal carcinoma resection with left-neck esophagogastric anastomosis in the 2 groups indicated that the exposure of the RLN in group A resulted in an obviously lower rate of neck RLN injury after the surgery, compared to group B, where the RLN was not exposed. Exposure can lead to the avoidance of complications induced by RLN injury, such as dysarthria and choking cough when eating. As a result, satisfactory expectoration, which would diminish the incidence of pulmonary complications, can be reached allowing the patients to recover as early as possible. The results of our study suggest that the exposure of the RLN during the left -neck esophagogastric anastomosis has signi.cant clinical value, and that this approach can be recommended with con.dence.     

Extended Surgical Implication of Tubercle of Zuckerkandl in Total Thyroidectomy

The primary objective of the study was to assess the Tubercle of zuckerkandl (TZ) during thyroid surgeries and its relationship with RLN and Superior parathyroid (SP). A prospective study was done in, 30 consecutive cases of total thyroidectomy in whom per operatively TZ was identified. The presence of TZ, its laterality, size, relationship with RLN and parathyroid glands were documented. A grading system outlined by Pelizzo was applied in our current study. In majority of the cases the RLN was found to lie medial to TZ (26/30), followed by lateral position (3/30) and one case it was found to be posterior to TZ (1/30). The superior parathyroid was identified in close relation (< 2 cm) to the TZ in 27/30 cases. The distance between the TZ and SP was assessed. We proposed a classification for location of SP based on the distance between SP and TZ and also attempted to relate each class of SP location with TZ grade. There was strong association of Grade of TZ with the class of SP location (p value = 0.00046). TZ is constant surgical landmark with good reliability to identify the RLN and SP. RLN is found medial to TZ in majority of cases with few exceptions. SP is found to be closely associated with TZ in majority of cases and there is a strong relationship of proximity of SP and TZ with respect to TZ grade. Although this required further studies with larger population.     

甲状腺癌患者术中喉返神经的显露及损伤预防

背景与目的:喉返神经(recurrent laryngeal nerve,RLN)损伤是甲状腺手术最为严重的并发症之一,尤其在甲状腺癌手术时更易发生.喉返神经损伤和防护一直是甲状腺外科关注的焦点.本文旨在探讨甲状腺癌患者术中RLN显露及损伤的预防.方法:同顾性分析2002年1月至2006年7月收治的282例行甲状腺癌手术患者临床资料.结果:282例甲状腺癌患者术前4例发现RLN损伤,9例术中发现RLN受累,在环状软骨弓外下方2～3 cm区域气管食管间沟附近稍加分离即能见到RLN 505条(505/564,89.5%).所有患者在行颈淋巴结清扫前均未全程显露RLN,分离时紧靠甲状腺进行;对行颈部淋巴结清扫的患者先行RLN的全程显露.本组无手术死亡,术后并发症包括血肿1例,乳糜漏1例.1例冈肿瘤侵犯行单侧RLN切除;2例再手术患者行RLN松解及1例RLN吻合术,术后发音有所改善;术前检查无声带麻痹者,发生暂时性声嘶9例,永久性声嘶2例,1例因肿瘤侵犯喉行全喉切除及气管造口术.结论:RLN位于环状软骨弓外下方2～3 cm区域处位置表浅,易于显露.甲状腺癌在行甲状腺切除时,不必全程显露RLN:若需行颈淋巴结清扫,可先切除甲状腺,在其局部显露部位开始显露其全程,精细无血操作,能有效预防术中RLN损伤.损伤一经诊断应尽早修复.