Satoh Shinya, Tachibana Seigo, Yokoi Tadao, Yamashita Hiroyuki
Yamashita Thyroid and Parathyroid Clinic, Fukuoka.
Nihon Jibiinkoka Gakkai Kaiho. 2013 Jul;116(7):793-801. doi: 10.3950/jibiinkoka.116.793.
The right nonrecurrent inferior laryngeal nerve (NRILN), which is usually associated with the right aberrant subclavian artery, is a risk factor of nerve injury during thyroid surgery. Therefore the presence of the NRILN should be diagnosed if possible before surgery. The aim of this study was to investigate the usefulness of computed tomography (CT) and ultrasonography (US) for preoperative diagnosis of the right-sided NRILN.
We reviewed 1,561 patients who underwent thyroid surgery, during which the right inferior laryngeal nerve was exposed, at Yamashita thyroid and parathyroid clinic from April 2006 to April 2012. All medical records, CT findings and ultrasonograms of these patients were reviewed retrospectively.
We recognized 11 patients who had the right-sided NRILN from the total of 1561 patients (0.71%). Ten of 1086 patients who underwent CT, had a right aberrant subclavian artery. CT findings were enabled us to predict the existence of the right NRILN before surgery. The sensitivity and specificity of CT for detection of the right-sided NRILN were 100% and 100%. On the other hand, we could detect the bifurcation of the innominate artery in 116 of 140 patients with cervical US before surgery, and therefore could confirm that the right inferior laryngeal nerve of the 116 patients was normal. The bifurcation of the other patients was not detectable and one of the 24 patients only had the right-sided NRILN during surgery. The sensitivity and specificity of cervical US for detection of the right-sided NRILN were 100% and 83.5% respectively.
Although CT is extremely useful for preoperative diagnosis of the right-sided NRILN because of its accuracy, cervical US is also a good method for making sure that the right inferior laryngeal nerve is normal.
右侧非返性喉下神经（NRILN）通常与右侧迷走锁骨下动脉相关，是甲状腺手术中神经损伤的一个危险因素。因此，手术前应尽可能诊断出NRILN的存在。本研究的目的是探讨计算机断层扫描（CT）和超声检查（US）对右侧NRILN术前诊断的实用性。
我们回顾了2006年4月至2012年4月在山下甲状腺和甲状旁腺诊所接受甲状腺手术的1561例患者，术中暴露了右侧喉下神经。对这些患者的所有病历、CT检查结果和超声图像进行了回顾性分析。
在1561例患者中，我们识别出11例有右侧NRILN（0.71%）。在接受CT检查的1086例患者中，有10例存在右侧迷走锁骨下动脉。CT检查结果使我们能够在手术前预测右侧NRILN的存在。CT检测右侧NRILN的敏感性和特异性均为100%。另一方面，在140例接受颈部超声检查的患者中，我们在术前检测到116例无名动脉分叉，因此可以确认这116例患者的右侧喉下神经正常。其他患者的无名动脉分叉未检测到，24例患者中只有1例在手术中发现右侧NRILN。颈部超声检测右侧NRILN的敏感性和特异性分别为100%和83.5%。
尽管CT因其准确性对右侧NRILN的术前诊断极为有用，但颈部超声也是确保右侧喉下神经正常的一种好方法。
