同时显露双侧喉返神经在甲状腺手术中的应用

目的甲状腺术中观察喉返神经与甲状腺下动脉的关系，探讨避免因显露而造成医源性喉返神经损伤的预防措施。方法回顾分析昆明医学院第一附属医院胃肠与甲状腺外科1998年1月至2006年12月收治同时显露双侧喉返神经的1642例甲状腺手术的病历资料。结果所有患者均成功显露双侧喉返神经，发现右侧2条“非返性喉返神经”。左侧喉返神经主干位于甲状腺下动脉之前、之后和动脉分叉之间的比例分别为27．2％（446／1642）、41．7％（684／1642）和31．2％（512／1642）；右侧分别为20．2％（331／1642）、43．4％（712／1642）和36．4％（597／1642）。医源性损伤8例，永久性损伤3例，暂时性损伤5例。神经减压11例，半年内神经功能恢复7例。结论尽管喉返神经与甲状腺下动脉的关系不恒定，但经验丰富、熟悉喉返神经解剖特点的医师，术中耐心的显露辨认和保护可避免喉返神经的医源性损伤。

Bilateral recurrent laryngeal nerves exposure in thyroid operation

Objective To study the anatomical relationship between the recurrent laryngeal nerves （RLN） and the inferior thyroid artery and to investigate measures on how to avoid iatrogenic injuries while expo- sing RLN during thyroid operation. Methods The clinical data of 1 642 patients undergoing thyroid operation with bilateral RLNs exposure from Jan. 1998 to Dee. 2006 were retrospectively reviewed. Results All RLNs were successfully exposed （including 2 non-recurrent laryngeal nerves on the fight side）. On the left side, the nerve passed anterior to the artery in 27.2% （446/1 642）, posterior to it in 41.7% （684/1 642）, and between the branches of the artery in 31.2% （512/1 642）. On the right side, the nerve was found anterior to the artery in 20.2% （331/1 642） , posterior to it in 43.4% （712/1 642）, and between the branches in 36.4% （597/ 1 642 ）. 8 nerves were iatrogenically injured, 5 were temporarily injured and 3 were permanently injured. Within half years, 11 nerves were decompressed and 7 cases recovered. Conclusion Although the anatomical relation- ship between RLN and the inferior thyroid artery is variable, iatrogenic injuries of the nerves can be avoided by nerves exposure.