中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
6期
431-435
,共5页
张品一%张滨%刘垚%张伟峰
張品一%張濱%劉垚%張偉峰
장품일%장빈%류요%장위봉
甲状腺疾病%甲状腺切除术%喉返神经%解剖变异
甲狀腺疾病%甲狀腺切除術%喉返神經%解剖變異
갑상선질병%갑상선절제술%후반신경%해부변이
Thyroid diseases%Thyroidectomy%Recurrent laryngeal nerve%Anatomic variation
目的 总结甲状腺手术中发现的喉返神经解剖变异的特点,并探讨各种变异类型的识别与保护要点.方法 回顾性分析2010年6月至2012年6月1548例常规显露喉返神经的甲状腺手术患者的临床资料,总结术中喉返神经的变异类型、变异率及解剖特点,分析神经的损伤情况.结果 1548例患者手术中显露喉返神经共2620根,其中全程解剖1886根,损伤11根(0.42％).全组2620根喉返神经中,发生条件变异共64根.1886根全程解剖的喉返神经中,存在自然变异共421根(22.3％),包括分支形态变异126根(6.68％),走行位置变异124根(6.57％),甲状腺下动脉处变异36根(1.91％),Berry韧带处变异112根(5.94％),环甲关节处变异17根(0.80％),非返型变异6根(0.32％).结论 甲状腺手术中所见喉返神经的变异复杂多样、变异率较高,其导致术中对神经的错误识别是造成神经损伤的重要潜在因素；全面掌握正常与各种变异的解剖特点是甲状腺手术中成功显露并保护喉返神经的关键.
目的 總結甲狀腺手術中髮現的喉返神經解剖變異的特點,併探討各種變異類型的識彆與保護要點.方法 迴顧性分析2010年6月至2012年6月1548例常規顯露喉返神經的甲狀腺手術患者的臨床資料,總結術中喉返神經的變異類型、變異率及解剖特點,分析神經的損傷情況.結果 1548例患者手術中顯露喉返神經共2620根,其中全程解剖1886根,損傷11根(0.42％).全組2620根喉返神經中,髮生條件變異共64根.1886根全程解剖的喉返神經中,存在自然變異共421根(22.3％),包括分支形態變異126根(6.68％),走行位置變異124根(6.57％),甲狀腺下動脈處變異36根(1.91％),Berry韌帶處變異112根(5.94％),環甲關節處變異17根(0.80％),非返型變異6根(0.32％).結論 甲狀腺手術中所見喉返神經的變異複雜多樣、變異率較高,其導緻術中對神經的錯誤識彆是造成神經損傷的重要潛在因素；全麵掌握正常與各種變異的解剖特點是甲狀腺手術中成功顯露併保護喉返神經的關鍵.
목적 총결갑상선수술중발현적후반신경해부변이적특점,병탐토각충변이류형적식별여보호요점.방법 회고성분석2010년6월지2012년6월1548례상규현로후반신경적갑상선수술환자적림상자료,총결술중후반신경적변이류형、변이솔급해부특점,분석신경적손상정황.결과 1548례환자수술중현로후반신경공2620근,기중전정해부1886근,손상11근(0.42％).전조2620근후반신경중,발생조건변이공64근.1886근전정해부적후반신경중,존재자연변이공421근(22.3％),포괄분지형태변이126근(6.68％),주행위치변이124근(6.57％),갑상선하동맥처변이36근(1.91％),Berry인대처변이112근(5.94％),배갑관절처변이17근(0.80％),비반형변이6근(0.32％).결론 갑상선수술중소견후반신경적변이복잡다양、변이솔교고,기도치술중대신경적착오식별시조성신경손상적중요잠재인소；전면장악정상여각충변이적해부특점시갑상선수술중성공현로병보호후반신경적관건.
Objective To summarize the anatomic variations of recurrent laryngeal nerve (RLN during thyroid surgery and to investigate the technical key points for identification and preservation of the nerve.Methods Clinical data of 1548 consecutive patients undergoing thyroid operation with intraoperative routine exposure of RLN from June 2010 to June 2012 was retrospectively analyzed.Results In this series,2620 RLNs at risk were clearly exposed and identified during a total of 1548 thyroid operations,wherein complete dissection was performed on 1886 nerves.Injury occurred in 11 of 2620 (0.42％) nerves.Through the analysis of all 2620 RLNs,conditional variations were found in 64 nerves.Of 1886 RLNs that were completely dissected,421 (22.3％)nerves presented with natural variations of six patterns,including morphological branching variation in 126 (6.68％) nerves,course and location variation in 124 (6.57％)nerves,variation in relationship with inferior thyroid artery (ITA)in 36 (1.91％)nerves,variation at the Berry ligament in 112 (5.94％) nerves,variation at the cricothyroid joint in 17 (0.80％) nerves,and 6 (0.32％)cases of non-recurrent laryngeal nerve (nRLN).Conclusions Variations in RLN found during thyroid surgery are of relatively high incidence,complex and diverse,which can be a potential reason of nerve injury due to visual misidentification.Thus,a thorough knowledge of the normal anatomy of RLN and its anatomic variations ensures a safe and effective thyroid surgery.
