中华内分泌外科杂志
中華內分泌外科雜誌
중화내분비외과잡지
CHINESE JOURNAL OF ENDOCRINE SURGERY
2012年
4期
228-230
,共3页
王圣应%朱金海%朱正志%张荣新%彭德峰%张晖%姚廷敬%王子岩
王聖應%硃金海%硃正誌%張榮新%彭德峰%張暉%姚廷敬%王子巖
왕골응%주금해%주정지%장영신%팽덕봉%장휘%요정경%왕자암
甲状腺疾病%再次手术%喉返神经保护
甲狀腺疾病%再次手術%喉返神經保護
갑상선질병%재차수술%후반신경보호
Thyroid diseases%Reoperation%Recurrent laryngeal nerve protection
目的 探讨甲状腺疾病再次手术中喉返神经的显露与保护.方法 回顾性分析214例甲状腺疾病再次手术的临床资料,间隔较近再次手术或甲状腺癌外侵的患者从带状肌外侧、胸锁乳突肌前缘入路,在上纵膈气管食管沟外侧区或入喉处显露喉返神经,伴淋巴结转移的患者从肿大淋巴结旁显露喉返神经;再次手术间隔时间较长、良性或肿瘤未外侵的甲状腺癌从颈前中线显露甲状腺,从甲状腺中静脉平面的侧后方或甲状腺下动脉区显露喉返神经.结果 全组共解剖显露喉返神经344条(右侧188条,左侧156条),单侧显露84例,双侧显露130例.喉返神经入喉处显露44条,甲状腺中静脉平面的侧后方显露104条,甲状腺下动脉区显露40条,上纵膈气管食管沟外侧区124条,肿大淋巴结旁32条.其中首次手术于外院,术后当天即声音嘶哑的2例,入院再次手术时发现喉返神经在入喉处被缝线结扎.全组喉返神经分支损伤0.87%( 3/344).结论 甲状腺再次手术时,熟悉并识别喉返神经正常、变异或病理状况下的解剖,避开粘连、疤痕组织,选择适当的解剖途径显露喉返神经,可降低术中喉返神经的损伤发生.
目的 探討甲狀腺疾病再次手術中喉返神經的顯露與保護.方法 迴顧性分析214例甲狀腺疾病再次手術的臨床資料,間隔較近再次手術或甲狀腺癌外侵的患者從帶狀肌外側、胸鎖乳突肌前緣入路,在上縱膈氣管食管溝外側區或入喉處顯露喉返神經,伴淋巴結轉移的患者從腫大淋巴結徬顯露喉返神經;再次手術間隔時間較長、良性或腫瘤未外侵的甲狀腺癌從頸前中線顯露甲狀腺,從甲狀腺中靜脈平麵的側後方或甲狀腺下動脈區顯露喉返神經.結果 全組共解剖顯露喉返神經344條(右側188條,左側156條),單側顯露84例,雙側顯露130例.喉返神經入喉處顯露44條,甲狀腺中靜脈平麵的側後方顯露104條,甲狀腺下動脈區顯露40條,上縱膈氣管食管溝外側區124條,腫大淋巴結徬32條.其中首次手術于外院,術後噹天即聲音嘶啞的2例,入院再次手術時髮現喉返神經在入喉處被縫線結扎.全組喉返神經分支損傷0.87%( 3/344).結論 甲狀腺再次手術時,熟悉併識彆喉返神經正常、變異或病理狀況下的解剖,避開粘連、疤痕組織,選擇適噹的解剖途徑顯露喉返神經,可降低術中喉返神經的損傷髮生.
목적 탐토갑상선질병재차수술중후반신경적현로여보호.방법 회고성분석214례갑상선질병재차수술적림상자료,간격교근재차수술혹갑상선암외침적환자종대상기외측、흉쇄유돌기전연입로,재상종격기관식관구외측구혹입후처현로후반신경,반림파결전이적환자종종대림파결방현로후반신경;재차수술간격시간교장、량성혹종류미외침적갑상선암종경전중선현로갑상선,종갑상선중정맥평면적측후방혹갑상선하동맥구현로후반신경.결과 전조공해부현로후반신경344조(우측188조,좌측156조),단측현로84례,쌍측현로130례.후반신경입후처현로44조,갑상선중정맥평면적측후방현로104조,갑상선하동맥구현로40조,상종격기관식관구외측구124조,종대림파결방32조.기중수차수술우외원,술후당천즉성음시아적2례,입원재차수술시발현후반신경재입후처피봉선결찰.전조후반신경분지손상0.87%( 3/344).결론 갑상선재차수술시,숙실병식별후반신경정상、변이혹병리상황하적해부,피개점련、파흔조직,선택괄당적해부도경현로후반신경,가강저술중후반신경적손상발생.
Objective To investigate the exposure and protection of recurrent laryngeal nerve (RLN) in the reoperation for thyroid diseases.Methods Clinical data of 214 cases undergoing thyroid reoperation were retrospectively analyzed.The patients with a short interval between the 2 thyroid operations or with external-infiltrated thyroid cancer were approached at the lateral strap muscles and the leading edge of the sternocleidomastoid.RLNs were exposed in the lateral region of superior mediastinum tracheoesophageal groove or at the point where RLN enters to throat.RLNs of patients with lymph node metastasis were exposed beside the enlarged lymph nodes.The patients with a long interval between the 2 thyroid operations and with benign tumor or tumor without external infiltration were exposed their thyroids at the anterior midline and then RLNs were exposed at the posterior lateral of the middle thyroid veins or at the inferior thyroid artery.Results Among the 214 cases,344 RLNs were anatomically exposed including 188 right and 156 left.84 cases had single exposure and 130 cases had bilateral exposure.44 RLNs were exposed at the point where RLN enters to throat,104 RLNs at the posterior lateral of the middle thyroid veins,40 RLNs at the inferior thyroid artery,124 RLNs at the lateral region of superior mediastinum tracheoesophageal groove,and 32 RLNs beside the enlarged lymph nodes.For the 2 cases suffering hoarse voice the day after they underwent thyroid operation in other hospital,suture ligation at the the entrance point was found when they received the reoperation in our hospital.Three of the total 344 RLNs (0.87% ) had RLN branch injury in the entire group.Conclusion It is possible to reduce RLN injury during the reoperation for thyroid disease if surgeons are familiar with the dissection of RLN under normal or pathological condition,avoid adhesive or scar tissues,and select the appropriate anatomic approach.