头颈手术中喉返神经的显露法与功能保护

目的探讨喉返神经显露法在头颈外科手术中的应用。方法1 893例头颈手术患者,其中甲状腺手术1862例;良性病变1 524例,恶性338例;复发性第Ⅲ鳃裂瘘管14例,气管狭窄10例,气管腺样囊性癌与黏液表皮样癌各2例,颈段食道癌3例。术中均显露喉返神经,在直视下保护喉返神经并切除病变。手术后7 d均间接喉镜或电子喉镜检查声带运动功能。结果所有患者原发病灶完整切除,术后7 d发现2例良性甲状腺病变患者左侧喉返神经麻痹,随访3个月后恢复部分功能,其他患者声带活动正常。恶性肿瘤随访至今未见复发。结论喉返神经显露是头颈手术中一项重要技术,合理的显露方法可保证患者手术安全,避免损伤喉返神经。

Exposing and Protecting of Recurrent Laryngeal Nerve in Head and Neck Surgery

Objective To introduce several methods of exposing and protecting recurrent laryngeal nerve （RLN）and investigate their efficacy and complications in different head and neck surgery. Methods One thousand eight hundred and ninety three patients underwent the exposing and protecting procedures for RLN in head and neck surgery,in which there were 1 524 benign cases and 338 malignant thyroid diseases. Other cases were composed of recurrent Ⅲ bronchial fistulae（n = 14）, tracheal stenosis （n =10）, tracheal adenocystic carcinoma（n = 2）, tracheal mucoepidermoid carcinoma（n=2）and squamous cell carcinoma in cervical esophagus（n= 3）. All cases underwent meticulous exposing procedure for the course of recurrent laryngeal nerve. Lesions were resected with the RLN in a visualized condition and nerves were remained intact. The movements of vocal cord were checked for functional assessment by laryngoscope or electro-laryngoscope seven days later. Results Primary lesions had been laryngeal nerve was found in two cases on the removed successively. Paralysis of left recurrent seventh day postoperatively. Followed up for 3 months,the functions of RLN in these two eases have partially recovered. Vocal cord function of the others are normal. Malignant cases were followed by now without tumor recurrence. Conclusion The surgical procedures of exposing and protecting RLN play an important role in head and neck surgery. It has been demonstrated to he a safe operative method if correct skills and techniques were used and carefully performed by a experienced operator.