甲状腺手术中甲状旁腺和喉神经功能损伤的防治策略

外科手术是治疗甲状腺恶性肿瘤和部分良性肿瘤主要方法，其中分化型甲状腺癌（differentiated thyroid carcinoma，DTC）手术占绝大部分。尽管外科手术技术在不断发展和进步，但因甲状腺手术导致的甲状旁腺和神经功能损伤仍然不能完全避免。本文从甲状腺手术的方式和范围、局部解剖学变异和二次甲状腺手术的角度系统分析了导致甲状旁腺和喉神经（包括喉上神经和喉返神经）损伤的原因，从如何正确把握甲状腺肿瘤手术治疗的原则、适应证和手术中的精细化操作及围手术期的处理等方面详细论述了甲状腺手术中甲状旁腺和喉神经功能保护和恢复的原则与策略。本文旨在对临床上有效预防和妥善处理甲状腺手术的主要并发症提供参考。 

Principles and strategies for the prevention and treatment of parathyroid and larynge-al nerve injuries during thyroid surgery

Surgery is the major treatment option for malignant tumors and some benign neoplasms of the thyroid, most of which are differentiated thyroid carcinoma. Despite the progresses that have been made in surgical techniques, iatrogenic injuries of the parathy-roid and laryngeal nerves, including superior and recurrent laryngeal nerves, could not be completely avoided in the surgical manage-ment of thyroid tumors. In this review, the causes of intraoperative injuries of parathyroid and laryngeal nerves are systematically ana-lyzed with respect to types and extents of surgical operations, changes in topical anatomy, and secondary thyroid surgeries. The princi-ples and strategies for protecting and restoring injuries of the parathyroid and laryngeal nerves are also elucidated for the effective prevention and adequate treatment of these major complications in the thyroid surgery.