CAJ | 학술논문

目的分析甲状腺手术中因病变部位不同结合喉返神经解剖路径而采用不同的显露喉返神经入路的方法,以避免喉返神经的损伤.方法回顾性分析755例行甲状腺手术患者的资料,所有患者均在全身麻醉下进行,术中根据病变情况决定手术切除范围,结合喉返神经的解剖路径,术中常规显露喉返神经.结果 755例患者中共显露喉返神经963条,采用侧方入路显露658条、下方入路显露106条、上方入路显露199条;喉返神经位于甲状腺下动脉干深面通过694例、位于动脉干浅面通过119例、在动脉分支之间通过98例、神经分支与动脉分支交叉穿过者62例;喉返神经入喉前分支者578例、未分支直接入喉者385例,发现喉不返神经2例.外院术后声嘶6例中,术中探查发现神经被完全切断2例、神经被结扎4例;1例为初次术前即有声嘶,其余病例无一例发现术后声嘶.结论甲状腺病变的多样性及喉返神经解剖路径的复杂性,要求术中须根据具体情况灵活应用上方、侧方,下方入路解剖显露喉返神经,可降低喉返神经损伤的风险.
목적 분석갑상선수술중인병변부위불동결합후반신경해부로경이채용불동적현로후반신경입로적방법,이피면후반신경적손상.방법 회고성분석755례행갑상선수술환자적자료,소유환자균재전신마취하진행,술중근거병변정황결정수술절제범위,결합후반신경적해부로경,술중상규현로후반신경.결과 755례환자중공현로후반신경963조,채용측방입로현로658조、하방입로현로106조、상방입로현로199조;후반신경위우갑상선하동맥간심면통과694례、위우동맥간천면통과119례、재동맥분지지간통과98례、신경분지여동맥분지교차천과자62례;후반신경입후전분지자578례、미분지직접입후자385례,발현후불반신경2례.외원술후성시6례중,술중탐사발현신경피완전절단2례、신경피결찰4례;1례위초차술전즉유성시,기여병례무일례발현술후성시.결론 갑상선병변적다양성급후반신경해부로경적복잡성,요구술중수근거구체정황령활응용상방、측방,하방입로해부현로후반신경,가강저후반신경손상적풍험.
Objective To evaluate different methods to explose recurrent laryngeal nerve (RLN)based on the location of thyroid diseses and anatomic path of the RLN,to avoid the RLN damage in thyroid surgery.Methods A total of 755 cases underwent total lobectomy was studied retrospectively.RLN was explosed in each case.Results A total of 963 RLN was exposed in 755 cases,among those 658 RLN were exposed by lateral approach,106 by inferior approach,and 199 by superior approach.It was showed that 694 RLN traveled deep to the inferior throid artery and 119 superficial to the artery,98 through between two branches of the artery,and 62 with the cross of the nerve branches and the artery branches.Before entering larynx,578 RLN gave off branches and 385 had no branches.Non-recurrent laryngeal nerves were found in 2 cases.There were 6 cases who presented with hoarseness after thyroidectomy and undergoing reexploration,among them RLN were legated in 4 cases and severed in 2 cases.Conclusions The anatomic relation of RLN is relatively complicated.Lateral,inferior or superior aproach may be used for exposure of RLN to decrease risks of injury to the nerve.