甲状腺手术中喉返神经变异的临床研究

目的 总结喉返神经解剖变异特点,以降低甲状腺手术喉返神经损伤率.方法 对1270例患者充分显露的1772根喉返神经变异分布状况、变异发生率等进行统计学处理,以总结喉返神经解剖变异特点.结果 本组自然变异和条件变异分别有396根和59根,变异发生率分别为22.35％和3.33％.喉返神经损伤8根,喉返神经受损率为0.45％.其中：单侧暂时性损伤6根（0.34％）,术后2～14周恢复;双侧暂时性损伤1根（0.06％）,术后发生延迟性呼吸道阻塞,给予对症治疗后,患者声带功能在6个月后恢复正常;1例单侧永久性损伤（0.06％）.结论 喉返神经变异发生率较高,变异类型多样.这要求在甲状腺手术中必须对喉返神经的解剖特点有充分的认识,以降低喉返神经损伤的发生率.

Variation of recurrent laryngeal nerve in thyroid surgery

Objective To reduce the injury of recurrent laryngeal nerve （RLN） in thyroid operation summarizing the characteristics of the anatomic variation of recurrent laryngeal nerve.Methods The distribution,incidence of variation,etc.of 1772 fully revealed RLN in 1270 patients were statistically analyzed,then the anatomical variation characteristics of RLN were summarized.Results 396 nerves （22.35%） were natural variation and 59 （3.33%） conditional variation.8 RLN （0.45%） were injuried; of which,6 （0.34%） got unilateral temporary injury,and recovered 2-14 weeks after the surgery; 1 （0.06%） bilateral temporary injury,and the patient got delayed respiratory tract obstruction after the operation and his vocal cord function returned to normal 6 months after symptomatic treatment; and 1 （0.06%） unilateral permanent damage.Conclusions RLN variation has a high incidence and various types.In the operation of thyroid gland,the anatomic charactaristics of RLN should be fully understood to reduce the incidence of RLN injury.