解剖喉返神经在良性甲状腺疾病手术中的作用与意义

目的 探讨甲状腺手术中解剖喉返神经的意义.方法 选取70例良性甲状腺疾病手术患者并随机分为两组,各35例,对照组患者术中不常规解剖喉返神经,观察组患者术中常规解剖喉返神经,两组患者手术方式相同,其中单侧肿块行腺叶次全切除术,双侧肿块行一侧腺叶行次全切除加对侧部分切除或肿块切除,或者行双侧次全切除.观察两组患者术中喉返神经损伤情况及术后发生声音嘶哑及声带麻痹等并发症情况.同时分析观察患者喉返神经解剖情况及两组患者手术情况,并记录两组患者住院时间.结果 观察组患者术后2例出现声音嘶哑,均因麻醉插管引起,无1例发生喉返神经损伤.对照组患者2例喉返神经损伤,术后出现声音嘶哑及声带麻痹者各2例,观察组喉返神经损伤及并发症发生率低于对照组,但差异不显著（P＞0.05）.两组患者手术时间及术中出血量无显著差异,但观察组住院时间明显缩短,与对照组比较差异显著（P＜0.05）.结论 甲状腺手术中解剖喉返神经可有效避免术后喉返神经的损伤,从而降低术后并发症的发生,有利于提高患者术后生活质量.

Effect and significance of anatomy of the recurrent laryngeal nerve in the surgery of benign thyroid disease

Objective To investigate the significance anatomy of the recurrent laryngeal nerve in the surgery of thyroid. Methods 70 cases of benign thyroid disease were randonily assigned into two groups,35 cases in the control group were not routinely dissected recur- rent laryngeal never, patients in observation group undergoing routine recurrent laryngeal nerve anatomy. Surgical approaches in both groups patients were the same,unilateral tumor undergoing gland subtotal hysterectomy, bilateral tumor side lobe contralateral subtotal resection and partial resection or excision, or bilateral subtotal hysterectomy. We observed the injured condition of recurent laryngeal neve and complications of the surgery and recorded the hospital stay of patients. Results Two patients in observation group had hoarse- ness due to anesthesia intubation,no case of recurrent laryngeal nerve injury. Respective two patients in control group had recurrent la- ryngeal nerve injury,postoperative hoarseness and vocal cord paralysis. The occurrence of recurrent laryngeal nerve injury and complica- tion rate in observation group was lower than those in the control group,but the difference was not significant （P 〉 0.05）. Two groups of patients had no significant differences in operation time and blood loss,but the observation group had significantly shorter hospital stay, compared with the control group,with significant differences （P 〈 0.05）. Conclusions Anatomy of recurrent laryngeal nerve in thyroid surgery can effectively prevent postoperative recurrent laryngeal nerve injury,thereby reducing the incidence of postoperative complica- tions,which helps to improve the quality of life of patients.