CAJ | 학술논문

目的探讨甲状腺手术中喉返神经的解剖、显露及手术方式在预防喉返神经损伤中的作用.方法回顾性分析行手术治疗的520例甲状腺疾病患者的临床资料,其中术中显露喉返神经268例,不显露喉返神经252例;行甲状腺大部切除手术方式232例,行患侧甲状腺腺叶切除+峡部+对侧大部分切除手术方式220例,行患侧甲状腺腺叶全切+对侧次全切+同侧淋巴结清扫手术方式68例.结果术中显露喉返神经的268例患者中,喉返神经喉外分支在入喉前为单支214例,占79.9％(214/268);分2支42例,占15.7％(42/268);分多支12例,占4.5％(12/268).喉返神经位于甲状腺下动脉后方穿过143例,占53.4％(143/268);位于甲状腺下动脉前方穿过92例,占34.3％(92/268);走行于甲状腺下动脉各分支之间33例,占12.3％(33/268).显露喉返神经者喉返神经永久性损伤发生率为1.1％(3/268),低于不显露喉返神经者的6.0％ (15/252),差异有统计学意义(P＜0.05).行甲状腺大部切除者与行患侧甲状腺腺叶切除+峡部+对侧大部分切除者喉返神经永久性损伤发生率比较差异无统计学意义(P＞0.05),与前二者比较,行患侧甲状腺腺叶全切+对侧次全切+同侧淋巴结清扫者喉返神经永久性损伤发生率明显增加,差异有统计学意义(P＜0.05).显露喉返神经患者中,良性病例173例,喉返神经短暂性损伤6例,永久性损伤1例;恶性病例95例,喉返神经短暂性损伤6例,永久性损伤2例,两者甲状腺永久性损伤发生率比较差异无统计学意义(P＞0.05).结论显露喉返神经手术方式可以明显降低喉返神经损伤的发生,对于局部甲状腺切除术,可以选择非显露喉返神经手术方式.
목적 탐토갑상선수술중후반신경적해부、현로급수술방식재예방후반신경손상중적작용.방법 회고성분석행수술치료적520례갑상선질병환자적림상자료,기중술중현로후반신경268례,불현로후반신경252례;행갑상선대부절제수술방식232례,행환측갑상선선협절제+협부+대측대부분절제수술방식220례,행환측갑상선선협전절+대측차전절+동측림파결청소수술방식68례.결과 술중현로후반신경적268례환자중,후반신경후외분지재입후전위단지214례,점79.9％(214/268);분2지42례,점15.7％(42/268);분다지12례,점4.5％(12/268).후반신경위우갑상선하동맥후방천과143례,점53.4％(143/268);위우갑상선하동맥전방천과92례,점34.3％(92/268);주행우갑상선하동맥각분지지간33례,점12.3％(33/268).현로후반신경자후반신경영구성손상발생솔위1.1％(3/268),저우불현로후반신경자적6.0％ (15/252),차이유통계학의의(P＜0.05).행갑상선대부절제자여행환측갑상선선협절제+협부+대측대부분절제자후반신경영구성손상발생솔비교차이무통계학의의(P＞0.05),여전이자비교,행환측갑상선선협전절+대측차전절+동측림파결청소자후반신경영구성손상발생솔명현증가,차이유통계학의의(P＜0.05).현로후반신경환자중,량성병례173례,후반신경단잠성손상6례,영구성손상1례;악성병례95례,후반신경단잠성손상6례,영구성손상2례,량자갑상선영구성손상발생솔비교차이무통계학의의(P＞0.05).결론 현로후반신경수술방식가이명현강저후반신경손상적발생,대우국부갑상선절제술,가이선택비현로후반신경수술방식.
Objective To study the anatomy,exposure and operation method in prevention of recurrent laryngeal nerve injury in thyroid surgery.Methods The clinical data of 520 patients with thyroid disease in treatment of operation were retrospectively analyzed,and exposure of recurrent laryngeal nerve in 268 cases,non exposure of recurrent laryngeal nerve in 252 cases; resection of the majority of thyroid in 232 cases,resection of ipsilateral thyroid lobe+ isthmus+on the side of most resection operation in 220 cases; resection of ipsilateral thyroid thyroidectomy+contralateral subtotal+ipsilateral lymph node dissection operation in 68 cases.Results Exposure of recurrent laryngeal nerve in 268 cases.The recurrent laryngeal nerve in the external laryngeal branch was single 214 cases,accounted for 79.9％ (214/268); two 42 cases,accounted for 15.7％ (42/268),more than 12 cases,accounted for 4.5％ (12/268).The laryngeal recurrent nerve during thyroid artery through the rear 143 cases,accounted for 53.4％(143/268) ; during thyroid artery through the front 92 cases,accounted for 34.3％ (92/268); walk line between thyroid artery branches 33 cases,accounted for 12.3％(33/268).The thyroid permanent damage rate of exposure of recurrent laryngeal nerve surgery was 1.1％(3/268),lower than that in non exposure of recurrent laryngeal nerve surgery 6.0％ (15/252) (P ＜ 0.05).The thyroid permanent damage rate between resection of the majority of thyroid and resection of ipsilateral thyroid lobe + isthmus + on the side of most resection operation had no significant difference (P ＞0.05),compared with the former two,resection of ipsilateral thyroid thyroidectomy + contralateral subtotal + ipsilateral lymph node dissection operation increased significantly (P ＜0.05).Exposure of.recurrent laryrngeal nerve in benign 173 cases,6 cases of thyroid transient damage,permanent damage in 1 case; 95 cases of malignant thyroid,6 cases of thyroid transient damage,permanent damage in 2 cases,the thyroid permanent damage rate in both had no significant difference (P ＞ 0.05).Conclusion Exposure of recurrent laryngeal nerve operation can significandy reduce the incidence of recurrent laryngeal nerve injury,for the partial thyroidectomy,can chose non exposure of recurrent laryngeal nerve operation method.