Watanabe A, Kawabori S, Osanai H, Taniguchi M, Hosokawa M
Department of Otolaryngology, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan.
Laryngoscope. 2001 Oct;111(10):1756-9. doi: 10.1097/00005537-200110000-00017.
The non-recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that is associated with the developmentally aberrant subclavian artery. Thus, it is possible to predict NRILN by preoperative diagnosis of an aberrant subclavian artery. Preoperative recognition of the NRILN should be advantageous in the prevention of intraoperative nerve damage. The purpose of this study was to assess the possibility of diagnosis of an aberrant subclavian artery by computed tomography (CT) of the neck, which is often performed before thyroid surgery.
We retrospectively studied the preoperative CT films from 594 thyroid or esophageal surgery patients treated in our hospital between May 1995 and December 2000. An NRILN was identified intraoperatively in 6 of these patients, and a right recurrent inferior laryngeal nerve (RILN) was observed in 588 of these patients. We evaluated whether the brachiocephalic artery could be identified on the CT scan and classified the positional relationship between the right subclavian artery and the tracheoesophagus into three types.
The brachiocephalic artery was identified on the CT films in 158 cases, all of which were cases of RILN. The right subclavian artery was detected on the ventral side of the membranous wall of the trachea in all 588 RILN cases, whereas it was detected on the dorsal side in all 6 NRILN cases.
It was possible to predict an aberrant subclavian artery by identifying the brachiocephalic artery and position of the right subclavian artery on the CT film of the neck. When an anomaly of the subclavian artery is thus preoperatively detected, NRILN can be preoperatively predicted, which likely will enable prevention of vocal cord paralysis.
非返性喉下神经（NRILN）是一种与发育异常的锁骨下动脉相关的神经异常。因此，通过术前诊断异常锁骨下动脉有可能预测NRILN。术前识别NRILN对预防术中神经损伤应具有重要意义。本研究的目的是评估通过颈部计算机断层扫描（CT）诊断异常锁骨下动脉的可能性，颈部CT扫描常在甲状腺手术前进行。
我们回顾性研究了1995年5月至2000年12月在我院接受治疗的594例甲状腺或食管手术患者的术前CT片。其中6例患者术中发现有NRILN，588例患者观察到右侧喉返神经（RILN）。我们评估了CT扫描上能否识别头臂动脉，并将右侧锁骨下动脉与气管食管的位置关系分为三种类型。
158例CT片上识别出头臂动脉，所有这些病例均为RILN。在所有588例RILN病例中，右侧锁骨下动脉在气管膜壁腹侧被检测到，而在所有6例NRILN病例中，右侧锁骨下动脉在背侧被检测到。
通过识别颈部CT片上头臂动脉和右侧锁骨下动脉的位置，可以预测异常锁骨下动脉。当术前检测到锁骨下动脉异常时，可以术前预测NRILN，这可能有助于预防声带麻痹。
