Shao Tanglei, Yang Weiping, Zhang Tao, Wang Yang, Jin Xiaotai, Li Qinyu, Kuang Jie, Qiu Weihua, Chu Peiguo G, Yen Yun
Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Invest Surg. 2010 Dec;23(6):314-20. doi: 10.3109/08941939.2010.509465.
We aimed to highlight a new anatomical variation of the recurrent laryngeal nerve (RLN), and to emphasize its implications for thyroid surgery.
A prospective study was carried out in a group of 3,078 consecutive thyroidectomies from 1998 to 2008. Total, near-total, subtotal, and partial thyroidectomy were performed for various thyroid diseases. The RLN was routinely identified and exposed in its entire course until the entry into the larynx. The postoperative complications of patients with different variations were compared.
4,241 RLNs were successfully identified in all patients unilaterally or bilaterally. In addition to extralaryngeal branching and nonrecurrent laryngeal nerves, an unreported variation was identified in 44 RLNs (1.04%) at their entries into the larynx. The variation happened at the trunk or the branches of the RLN entering the larynx far from the posterior of cricothyroid joint, and the entry was higher than the superior cornu of the thyroid cartilage and the arch of the cricoid. The median distance from the entry to the posterior of cricothyroid joint was more than 5 mm. As the trunk or the branches had to travel along the lateral edge of the upper 1/3 of the thyroid before entering the larynx, the incidence of RLN palsy was higher than that in extralaryngeal branching variations (p < .05).
This newly discovered variation of the RLN is more vulnerable to injury and should be brought to the attention of surgeons.
我们旨在突出喉返神经（RLN）一种新的解剖变异，并强调其对甲状腺手术的影响。
对1998年至2008年连续进行的3078例甲状腺切除术患者进行了一项前瞻性研究。针对各种甲状腺疾病实施了全甲状腺切除术、近全甲状腺切除术、次全甲状腺切除术和部分甲状腺切除术。常规识别并暴露RLN的全程直至其进入喉部。比较了不同变异患者的术后并发症。
在所有患者中成功单侧或双侧识别出4241条RLN。除了喉外分支和非喉返神经外，在44条RLN（1.04%）进入喉部时发现了一种未报告的变异。该变异发生在RLN进入喉部的主干或分支处，远离环甲关节后方，且入口高于甲状软骨上角和环状软骨弓。入口到环甲关节后方的中位距离超过5mm。由于主干或分支在进入喉部前必须沿甲状腺上1/3的外侧缘走行，因此RLN麻痹的发生率高于喉外分支变异（p < 0.05）。
这种新发现的RLN变异更容易受到损伤，应引起外科医生的注意。
