甲状腺良性病变手术预防喉返神经损伤的方法

目的 探讨甲状腺良性病变手术喉返神经显露的方法.方法 回顾分析2243例甲状腺良性病变手术资料,对甲状腺良性病变不同病变位置、不同手术方法与喉返神经损伤的关系进行比较分析.结果 本组共发生喉返神经损伤68例(3.0%).其中显露喉返神经手术中,背侧组喉返神经损伤率为1.0%(1/97),位于其他部位组,无喉返神经损伤.喉返神经区域保护法手术中,背侧组喉返神经损伤率为7.6%(65/853),病变位于甲状腺其他部位组喉返神经损伤率为0.17%(2/1195).结论 甲状腺良性病变手术,对于病变位于背侧的结节或腺瘤、甲状腺再次手术以及术中发生声音改变者,应常规显露喉返神经,其他情况则采用喉返神经区域保护法.显露方法可采用侧方、上方及下方三种途径.

Prevention of recurrent laryngeal nerve injury during operation in benige thyroid neoplasms

OBJECTIVE To investigate the reasons and preventive measures of recurrent laryngeal nerve injury during operation in patients with benign thyroid neoplasm. METHODS The clinical data of 2243 cases with benign thyroid neoplasm were reviewed. The relations among different neoplasm regions, different procedures and injury of recurrent laryngeal nerve were analyzed. RESULTS Injury incidence of recurrent laryngeal nerve in this study was 3.0 %. In cases with nodular goiter on the dorsum of thyroid and recurrent laryngeal nerve exposed during operation, injury incidence of recurrent laryngeal nerve was 1.0 %. And there was no recurrent laryngeal nerve injury in cases with nodular goiter on other region of the thyroid. In cases used locality protection during operation, injury incidence of recurrent laryngeal nerve was 7.6 % when benign lesions on the dorsum of thyroid and was 0.17 % when benign lesions on other region of the thyroid. CONCLUSION In cases with nodular goiter or adenoma on the dorsum of thyroid, exposing recurrent laryngeal nerve is necessary during operation and in cases with benign lesions on other region of thyroid, locality protection is useful. There are three major routes for recurrent laryngeal nerve exposure.