中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
10期
1066-1068
,共3页
刘洪沨%高维生%刘雯静%刘跃武%李小毅%袁宏伟%谢勇%陈曙光
劉洪沨%高維生%劉雯靜%劉躍武%李小毅%袁宏偉%謝勇%陳曙光
류홍풍%고유생%류문정%류약무%리소의%원굉위%사용%진서광
甲状腺%再手术%喉返神经%解剖
甲狀腺%再手術%喉返神經%解剖
갑상선%재수술%후반신경%해부
Thyroid%Reoperative thyroidectomy%Recurrent laryngeal nerve%Anatomy
目的 探讨甲状腺再次手术喉返神经的解剖入路方法.方法 回顾性分析55例因甲状腺疾病再次手术患者的临床资料.结果 55例甲状腺再次手术患者,甲状腺良性疾病术后接受再次手术16例,甲状腺癌术后接受再次手术39例.其中接受第3次手术4例,均为甲状腺癌术后.手术采用气管插管全身麻醉,原手术切口适度延长、正中入路游离皮瓣,横断手术侧舌骨下肌群,充分显露手术视野,再以气管、残余甲状腺组织、甲状软骨下角及颈总动脉作为解剖喉返神经入路标志进行解剖喉返神经,5例术中辅助应用喉返神经探测仪.其中,以气管、残余甲状腺为标志,由内向外解剖出喉返神经32例;以甲状软骨下角为标志,由上向下解剖出喉返神经9例;以颈总动脉为标志,由外向内解剖出喉返神经14例.术后患者恢复基本良好,发生说话声音改变8例,包括声音嘶哑3例,均于术后2个月内恢复.结论 甲状腺疾病再次手术,解剖喉返神经十分必要,气管、残余甲状腺、甲状软骨下角及颈总动脉可作为解剖喉返神经入路的解剖标志.
目的 探討甲狀腺再次手術喉返神經的解剖入路方法.方法 迴顧性分析55例因甲狀腺疾病再次手術患者的臨床資料.結果 55例甲狀腺再次手術患者,甲狀腺良性疾病術後接受再次手術16例,甲狀腺癌術後接受再次手術39例.其中接受第3次手術4例,均為甲狀腺癌術後.手術採用氣管插管全身痳醉,原手術切口適度延長、正中入路遊離皮瓣,橫斷手術側舌骨下肌群,充分顯露手術視野,再以氣管、殘餘甲狀腺組織、甲狀軟骨下角及頸總動脈作為解剖喉返神經入路標誌進行解剖喉返神經,5例術中輔助應用喉返神經探測儀.其中,以氣管、殘餘甲狀腺為標誌,由內嚮外解剖齣喉返神經32例;以甲狀軟骨下角為標誌,由上嚮下解剖齣喉返神經9例;以頸總動脈為標誌,由外嚮內解剖齣喉返神經14例.術後患者恢複基本良好,髮生說話聲音改變8例,包括聲音嘶啞3例,均于術後2箇月內恢複.結論 甲狀腺疾病再次手術,解剖喉返神經十分必要,氣管、殘餘甲狀腺、甲狀軟骨下角及頸總動脈可作為解剖喉返神經入路的解剖標誌.
목적 탐토갑상선재차수술후반신경적해부입로방법.방법 회고성분석55례인갑상선질병재차수술환자적림상자료.결과 55례갑상선재차수술환자,갑상선량성질병술후접수재차수술16례,갑상선암술후접수재차수술39례.기중접수제3차수술4례,균위갑상선암술후.수술채용기관삽관전신마취,원수술절구괄도연장、정중입로유리피판,횡단수술측설골하기군,충분현로수술시야,재이기관、잔여갑상선조직、갑상연골하각급경총동맥작위해부후반신경입로표지진행해부후반신경,5례술중보조응용후반신경탐측의.기중,이기관、잔여갑상선위표지,유내향외해부출후반신경32례;이갑상연골하각위표지,유상향하해부출후반신경9례;이경총동맥위표지,유외향내해부출후반신경14례.술후환자회복기본량호,발생설화성음개변8례,포괄성음시아3례,균우술후2개월내회복.결론 갑상선질병재차수술,해부후반신경십분필요,기관、잔여갑상선、갑상연골하각급경총동맥가작위해부후반신경입로적해부표지.
Objective To investigate the anatomic method of recurrent laryngeal nerve (RLN) in thyroid operation again.Methods From Jun.2002 to Sep.2012,55 patients who had received reoperative thyroidectomy were enrolled in this retrospective study.We analyzed the protection of RLN at the time of thyroidectomy reoperation,reasons for recurrent thyroid disease.Results Reoperative thyroidectomy was performed in 55 patients.Of whom,16 cases with benign and 39 cases with malignant were for second operation and 4 cases with malignant were underwent the third operation.Thyroidectomy was done under general anesthesia through a horizontal incision at the original collar line.Separating and cutting the Strap Muscles (sternohyoid,omohyoid and sternothyroid muscles) and exposing the anterior surface of the thyroid were performed.It is the most important anatomic sign,including the trachea,residual thyroid tissue,the inferior comu of thyroid cartilage and carotid artery,and then identified the RLN.Laryngeal nerve monitoring was performed in 5 of these 55 cases.We separated the RLN respectively by the sign of trachea and residual thyroid tissue for 32 cases.9 cases were underwent the inferior cornu of thyroid cartilage(from up to down),and 14 cases were performed at the carotid artery from outside to inside.We analyzed the all cases with good postreoperative outcomes.Forty-seven cases are alive with no complication,and 8 cases with voice changing,in which 3 cases occurred unintentional RLN paralysis and get recovery within 2 months.Conclusion More care should be taken while separating the tissue so as to avoid injury to the external laryngeal nerve.The trachea,residual thyroid tissue,the inferior comu of thyroid cartilage and Carotid artery are the important anatomic signs to identify the RLN.