显露喉返神经的甲状腺手术574例

目的　探讨甲状腺手术中喉返神经 (RLN )显露的方法和在预防喉返神经损伤中的作用。方法　近 5年来 ,我院对 5 74例 (10 10侧 )甲状腺切除术患者在术中显露喉返神经 ,然后再行甲状腺的次全切除术和甲状腺叶全切除术。结果　显露喉返神经甲状腺切除术喉返神经损伤 3例 ,其中暂时性损伤 1例 ,永久性损伤 2例 ,损伤率为 0 .3 0 %。结论　甲状腺切除术中显露喉返神经可以降低喉返神经损伤的发生率 ,特别是在甲状腺叶全切手术时。喉返神经显露必须遵循规范化操作原则 ,首先在甲状腺下极甲状腺下动脉周围寻找喉返神经 ,如有困难可在喉返神经入喉处寻找喉返神经 ,亦可以在颈动脉鞘迷走神经附近寻找喉返神经。

Exposure of recurrent laryngeal nerve in thyroid surgery:a report of 574 cases

Objective To study the method and effect of exposure the recurrent laryngeal nerve(RLN) in preventing the damage of RLN in thyroid surgery. Methods One thousand and ten sides total and(or) subtotal thyroidectomies were operated on 574 cases with RLN exposure in our hospital in recent 9 years. Results The RLN injury rate was 0.3% in this series.Of them, permanent RLN injury occurred in 2 cases and temporary injury in 1. Conclusions The exposure of RLN can greatly decrease the nerve injure in thyroid surgery, especially in total lobectomy. The dissection of RLN must followed the principle of RLN exposure . RLN should be dissected around the inferior thyroid artery first, if the RLN is difficult to be found,then dissecting around the thyroid cartilage, or finding the cervical vagus inside of carotid sheath to find RLN should be done.