Chang Shi, Tang Hui-Huan, Wang Cun-Chuan, Zhou Le-Du, Li Jin-Dong, Huang Yun, Zeng Qing-Jun, Wang Zhi-Ming
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
J Laparoendosc Adv Surg Tech A. 2012 Apr;22(3):259-63. doi: 10.1089/lap.2011.0320. Epub 2012 Feb 15.
Exposing the recurrent laryngeal nerve (RLN) during all types of thyroid surgery is essential to protect this nerve. Endoscopic thyroidectomy (ET) has gained acceptance from both patients and physicians, in part due to the cosmetic benefits. Therefore, the avoidance of intraoperative RLN impairment during ET is of critical significance. We have developed a standard approach to expose the RLN during ET that prevents RNL impairment.
ET was performed in 120 consecutive patients with thyroid disease. In order to develop a standard procedure that protects the RLN, several steps that differed from the traditional open procedure were introduced. First, the thyroid gland was freed from the isthmus instead of the superior pole. Then, the inferior pole of the thyroid gland was meticulously freed, and the lateral side of the thyroid gland was freed followed by the superior pole. At this point, the RLN was easily visualized in the tracheoesophageal groove. The thyroidectomy was then performed simultaneously with exposure of the RLN from the inferior to superior aspects. All RLNs were exposed when hemithyroidectomies, subtotal thyroidectomies, or total thyroidectomies were performed. The operative time and parathyroid hormone (PTH) and calcium levels were recorded prospectively and analyzed.
Using this method, all RLNs were easily exposed within 15 minutes. Only one case of transient RLN palsy occurred due to accidental contact of the harmonic scalpel to the nerve. Postoperative hypocalcemia occurred in 23 cases (19.2%), and the PTH level decreased significantly in 33 cases (27.5%). The PTH levels returned to normal within 3 months.
Use of the described approach to expose and protect the RLN when performing ET is safe and feasible.
在各类甲状腺手术中显露喉返神经（RLN）对于保护该神经至关重要。内镜甲状腺切除术（ET）已获得患者和医生的认可，部分原因在于其美容效果。因此，在ET术中避免喉返神经损伤具有关键意义。我们已开发出一种在ET术中显露RLN的标准方法，可防止RLN损伤。
对120例连续的甲状腺疾病患者进行了ET。为制定保护RLN的标准程序，引入了几个与传统开放手术不同的步骤。首先，从峡部而非上极游离甲状腺。然后，细致地游离甲状腺下极，接着游离甲状腺外侧，随后是上极。此时，在气管食管沟中可轻松看到RLN。然后在从下向上显露RLN的同时进行甲状腺切除术。在进行半甲状腺切除术、次全甲状腺切除术或全甲状腺切除术时，所有RLN均被显露。前瞻性记录并分析手术时间、甲状旁腺激素（PTH）和钙水平。
使用该方法，所有RLN均能在15分钟内轻松显露。仅1例因超声刀意外接触神经导致短暂性RLN麻痹。23例（19.2%）发生术后低钙血症，33例（27.5%）PTH水平显著下降。PTH水平在3个月内恢复正常。
在进行ET时，使用所描述的方法显露和保护RLN是安全可行的。
