Berry韧带与喉返神经的解剖及临床意义

目的探讨Berry韧带区域解剖关系,为安全实施甲状腺手术及避免喉返神经(RLN)损伤提供临床应用解剖依据。方法将2011年10月至2013年6月在广西医科大学附属武鸣医院行甲状腺手术治疗的131例患者设为对照组,术中均未显露RLN;将2014年1月至2015年12月行甲状腺手术治疗的124例患者设为观察组,术中进行Berry韧带区域解剖并显露RLN,对RLN及其分支与Berry韧带位置关系类型等相关数据资料进行分析,比较2组患者的RLN损伤率。结果观察组RLN损伤率显著低于对照组,差异有统计学意义(P<0.05)。观察组共解剖187根RLN,RLN及其分支与Berry韧带的位置关系可分为Type1、Type2、Type3、Type4及Type5共5种类型,各类型分布情况为Type1占12.8%、Type2占69.0%、Type3占1.1%、Type4占0.5%、Type5占16.6%。结论RLN在入喉前无分支且位于Berry韧带侧边为较常见的解剖关系,熟悉撑握这一解剖要点对甲状腺手术中识别RLN和避免RLN损伤有重要意义。

Anatomical and clinical significance of Berry ligament and recurrent laryngeal nerve

Objective To explore the regional anatomical relationship of Berry ligament,and to provide clinical anatomical basis for safe thyroid surgery and prevention of recurrent laryngeal nerve(RLN)injury.Methods A total of 131 patients who underwent thyroid surgery(without intraoperative exposure of RLN)in Wuming hospital affiliated to Guangxi medical university from October 2011 to June 2013 were selected as the control group,and the other 124 patients who underwent thyroid surgery(with Berry ligament area dissected and RLN exposed during the surgery)from January 2014 to December 2015 were included in the observation group.Position relation types of RLN and its branches with Berry ligament were compared,and the injury rate of RLN in the two groups was compared.Results The RLN injury rate of the observation group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).A total of 187 RLN were dissected in the observation group,and the position relationship between RLN and its branches and Berry ligament could be divided into 5 types.The distribution of each type was as follows:Type1(12.8%),Type2(69.0%),Type3(1.1%),Type4(0.5%),Type5(16.6%).Conclusion The commonest anatomical relationship is RLN located on the lateral side of Berry ligament without branches before entering the larynx.Familiarity with this anatomical point is important to identify and avoid RLN injury in thyroid surgery.