甲状腺手术喉返神经损伤的预防和治疗

目的评价甲状腺手术中解剖喉返神经损伤的必要性。方法将手术治疗的甲状腺疾病患者64例按术中是否解剖喉返神经分为解剖组和未解剖组,比较两组间喉返神经损伤的发生率。结果全组解剖喉返神经组32例,术后出现声嘶3例（9.3%）,未解剖神经组32例,术后出现声嘶5例（15.6%）,两组比较差异无统计学意义（P〈0.05）,但在存在有吼返神经损伤高危因素的患者中解剖与未解剖神经患者神经损伤率则有差异。结论是否解剖喉返神经应根据具体情况决定,对大多数甲状腺良性病变尽可能不显露喉返神经,但对于巨大甲状腺肿瘤、二次或多次手术及甲状腺癌应暴露喉返神经。

Prevention and treatment of recurrent laryngeal nerve injury during thyroid operation

Objective To evaluate the necessity of dissect the recurrent laryngeal nerve in operation of thyroid gland.Methods From March 2001 to Mar 2010,there were 512 patients in our hospital who underwent operation of thyroid gland,and they were divided into two groups according to whether or not the recurrent laryngeal nerve was dissected during the operation.The rate of injury of recurrent laryngeal nerve between the two group was compared.Results Among the 32 cases in dissection of recurrent laryngeal nerve group,3 cases（9.3%）had hoarseness after operation,and in the 323 cases without dissection of the recurrent laryngeal nerve group,5 cases（15.6%）had hoarseness after operation,but the difference was not significant.Howere,in the high risk cases between the two groups,the different was significant.Conclusion Whether or not dissect the recurrent laryngeal nerve should be decided by the specific circumstances.For most benign lesions,one should,if possible,not expose the recurrent laryngeal nerve,but for large thyroid neoplasms,second or multiple operations and thyroid cancer,exposure of recurrent laryngeal nerve is necessary.