精细被膜解剖法在甲状腺手术中预防喉返神经与甲状旁腺损伤的应用

目的：探讨甲状腺手术中应用精细被膜解剖法预防喉返神经与甲状旁腺损伤的方法和效果。方法回顾性分析2007年6月-2012年6月195例应用精细被膜解剖法行甲状腺手术的临床资料。均沿甲状腺真假被膜之间疏松间隙进行超微化解剖，贴近甲状腺真被膜进行血管离断的精细被膜解剖手术方法。结果195例手术均获成功，术中明确见到喉返神经9例。暂时性喉返神经麻痹4例（2．1％），永久性麻痹1例（0．5％），其余均无永久性喉返神经、喉上神经损伤及永久性甲状旁腺功能减退。结论运用精细被膜解剖法不仅可以有效避免喉上神经及喉返神经损伤，还可以原位保留甲状旁腺及其滋养血管。

Application of Meticulous Capsular Dissection Technique in the Prevention of Recurrent Laryngeal Nerve and Parathyroid Injuries in Thyroid Operations

Objective To assess the application and effects of meticulous capsular dissection technique in the prevention of recurrent laryngeal nerve and parathyroid injuries in thyroid operations . Methods A retrospective analysis of clinical data of 195 cases which received meticulous capsular dissection technique in thyroid operations from June 2007 to June 2012 was carried out .All the cases were supermicro-dissected in the loose clearance between real and false thyroid capsules , leaving the blood vessel dissected close to the real thyroid capsule . Results The operation was successfully performed in all the 195 patients, with recurrent laryngeal nerve clearly exposed in the operation in 9 patients.There were 4 cases of transient recurrent laryngeal nerve paralysis （2.1%） and 1 case of permanent paralysis （0.5%）.No permanent recurrent laryngeal nerve and superior laryngeal nerve injuries and permanent hypoparathyroidism happened in the remaining cases . Conclusion The use of meticulous capsular dissection technique not only can effectively avoid the superior laryngeal nerve and recurrent laryngeal nerve injuries , but also can preserve in situ parathyroid glands and their nutrient vessels .