甲状腺外科无喉返神经损伤的可能性

目的探讨甲状腺外科手术喉返神经(recurrenlaryngealnerve,RLN)零损伤的可能性。方法回顾性分析我科2001年3月～2005年3月659例甲状腺疾病的手术方式、术后RLN损伤、甲状旁腺功能低下、术后出血和术后复发等并发症的发生。术中常规解剖RLN,保护并勿过度解剖甲状旁腺及其供应的血管。结果甲状腺一侧腺叶加对侧腺叶部分切除376例、甲状腺一侧腺叶加峡部切除87例、甲状腺双侧腺叶次全切除76例、甲状腺全切除73例、颈部低位领式切口入路切除胸骨后结节性甲状腺肿47例。术后无一例发生RLN损伤。术后暂时性低钙血症发生率为1.67%(11/659)。无永久性低钙血症。术后出血需再手术止血和术后伤口血肿的发生率分别为0.60%(4/659)和0.45%(3/659)。甲状腺功能低下和术后复发的发生率分别为0.45%(3/659)和0.15%(1/659),无切口感染。结论甲状腺外科手术中熟悉RLN的解剖知识,常规紧贴甲状腺被膜外分离并全程解剖RLN及其分支可避免RLN的损伤。

Possibility of no recurrent laryngeal nerve injury in thyroid surgery

OBJECTIVE To explore the possibility of no recurrent laryngeal nerve injury in thyroid surgery. METHODS A total of 659 consecutive patients with thyroid disease undergoing thyroidectomy byotolaryngologists from March 2001 to March 2005 were retrospectively analyzed. The operative mode and incidence of complications, particularly postoperative RLN palsy, hypoparathyroidism and postoperative recurrence were evaluated. Routine dissection and identification of the RLN was performed during all operative procedures and parathyroid with the blood supply was preserved. RESULTS Unilateral total thyroidectomy with contralateral partial lobectomy was performed in 376 cases, unilateral total thyroidectomy with isthmectomy in 87, bilateral subtotal thyroidectomy with the remnant left at the upper pole in 76, total thyroidectomy in 73. The operations on 47 patients with substernal goiter have been successfully performed via cervical collar incision. None of our patients incurred unilateral or bilateral vocal cord paralysis and permanent hypocalcaemia. Of these patients, the incidence of temporary postoperative hypocalcemia was 1.67 %(11/659). Postoperative hemorrhage requiring reoperation occurred in 4 cases (0.60 %) and 5 patients developed wound haematomas (0.76 %).Postoperative hypothyroidism was found in 3 patients(0.45 %).The incidence of postoperative recurrence was 0.15 %(1/659). No patients had incision infection. CONCLUSION With knowledge of the anatomy of the RLN and routinely complete identification the RLN in performing capsular dissection high on the surface of the thyroid gland, RLN injury may be avoided in thyroid surgery.