CAJ | 학술논문

喉返神经损伤是甲状腺术后严重的并发症之一,单侧损伤引起声音嘶哑、双侧损伤则导致呼吸困难,甚至发生危及生命的声门梗阻.分析甲状腺损伤的原因:喉返神经与甲状腺下动脉紧密复杂的关系、喉返神经存在分支及分支的变异、喉不返神经、以及甲状腺Zuckerkandl结节的存在等解剖因素造成其易损伤;喉返神经本身的脆弱性造成其易损;未能合理使用能量手术器械造成神经的热损伤.预防喉返神经损伤可从以下方面努力:在甲状腺术中解剖显露喉返神经,使其“可视化”;术中精细化解剖喉返神经,解剖程度适中;掌握能量器械的性能,安全使用能量器械以减少神经的热损伤;合理使用术中神经监测,使用连续性神经监测,有助于降低喉返神经损伤的风险.
후반신경손상시갑상선술후엄중적병발증지일,단측손상인기성음시아、쌍측손상칙도치호흡곤난,심지발생위급생명적성문경조.분석갑상선손상적원인:후반신경여갑상선하동맥긴밀복잡적관계、후반신경존재분지급분지적변이、후불반신경、이급갑상선Zuckerkandl결절적존재등해부인소조성기역손상;후반신경본신적취약성조성기역손;미능합리사용능량수술기계조성신경적열손상.예방후반신경손상가종이하방면노력:재갑상선술중해부현로후반신경,사기“가시화”;술중정세화해부후반신경,해부정도괄중;장악능량기계적성능,안전사용능량기계이감소신경적열손상;합리사용술중신경감측,사용련속성신경감측,유조우강저후반신경손상적풍험.
Recurrent laryngeal nerve injury is one of the serious complications after thyroidectomy.Unilateral injury causes hoarseness,while bilateral injury causes difficulty in breathing or even life-threatening glottis obstruction.Analyzing the root cause of the thyroid injury,firstly it is the anatomical factors of recurrent laryngeal nerve,namely the close and complex relationship between the recurrent laryngeal nerve and the inferior thyroid artery,the existence of branches of recurrent laryngeal nerve and its variation,and the presence of non recurrent laryngeal nerve and Zuckerkandl nodules.Those are all made the recurrent laryngeal nerve easy to be damaged.Secondly it is because of the vulnerability of the recurrent laryngeal nerve itself.Last improper using of energy operation instrument will cause heat injury on nerves.Below counter measures can be implemented to prevent recurrent laryngeal nerve injury.Dissect to show recurrent laryngeal nerve or make it ‘ visualization’ during thyroidectomy.Elaborately anatomize recurrent laryngeal nerve to appropriate degree.Be familiar with the property of energy operation instrument and thus safely use them to reduce the heat injury of recurrent laryngeal nerve.Reasonably use the intraoperative nerve monitoring in the surgery,which assist to reduce the risk of injury of recurrent laryngeal nerve.