CAJ | 학술논문

目的探讨甲状腺术中喉返神经的解剖及显露的临床意义，以减少喉返神经损伤。方法回顾性分析965例甲状腺手术患者的临床资料，所有手术均在全痳下进行并常规显露喉返神经，手术切除范围由病变情况决定，并对喉返神经解剖特点、损伤情况进行分析。结果共解剖显露喉返神经1052条，其中右侧721条，左侧331条，包括双侧87条；采用上方入路解剖86条，侧方661条，下方305条；右侧喉返神经位于气管食管沟内走行者461条，偏离者260条；左侧位于气管食管沟内走行者285条，偏离者46条；喉返神经入喉前有分支者687条（65.3%），未分支直接入喉者365条（34.7%）；喉不返神经2条；解剖神经平均用时（6.7±0.54）min；术后神经暂时性损伤11例，永久性损伤2例，均于6个月后对侧声带代偿，嘶哑改善。结论熟悉喉返神经的解剖，灵活运用不同的解剖入路，常规解剖显露神经，是避免喉返神经损伤的有效方法。
목적탐토갑상선술중후반신경적해부급현로적림상의의，이감소후반신경손상。방법회고성분석965례갑상선수술환자적림상자료，소유수술균재전림하진행병상규현로후반신경，수술절제범위유병변정황결정，병대후반신경해부특점、손상정황진행분석。결과공해부현로후반신경1052조，기중우측721조，좌측331조，포괄쌍측87조；채용상방입로해부86조，측방661조，하방305조；우측후반신경위우기관식관구내주행자461조，편리자260조；좌측위우기관식관구내주행자285조，편리자46조；후반신경입후전유분지자687조（65.3%），미분지직접입후자365조（34.7%）；후불반신경2조；해부신경평균용시（6.7±0.54）min；술후신경잠시성손상11례，영구성손상2례，균우6개월후대측성대대상，시아개선。결론숙실후반신경적해부，령활운용불동적해부입로，상규해부현로신경，시피면후반신경손상적유효방법。
Objective To study the anatomic feature and exposing methods of recurrent laryngeal nerve(RLN) in thyroid surgery and to reduce the RLN injury. Methods The data of nine hundred and sixty-five cases were analyzed retrospectively, who were operated with total lobectomies. All RLNs were anatomically exposed, the resection part was chosen for the diseases' feature, and the anatomic feature and injury of RLN were discussed. Results One thousand and fifty-two RLNs were exposed, including 721 nerves of right side and 331 nerves of left side, 87 nerves in both sides. 86 nerves were by superior exposure, 661 by lateral exposure, and 305 nerves by inferior exposure. Among all nerves, 461 went along the tracheoesophageal groove and 260 nerves deviated it in right, 285 went along it and 46 nerves deviated it in left, 687 RLNs (65.3%) had branches into laryngeal, 365 RLNs (34.7%) had no branches, and two non-recurrent laryngeal nerves were found in these cases. It took (6.7±0.54) minutes on average to reveal nerves. Eleven cases had temporary postoperative nerve injuries, 2 had permanent nerve injuries, and all cases improved for the other vocal cord surpassed compensation after 6 months. Conclusion To realize the anatomic feature of RLN, to use the different routes to reveal the RLN and to expose every RLN are very useful for avoiding the injury of RLN.