Ma Xiangdong, Han Xilin, Liu Tao, Kou Changhua
Department of Tumor Surgery, Central Hospital of Xuzhou, 221009 Xuzhou, China. Email:
Department of Tumor Surgery, Central Hospital of Xuzhou, 221009 Xuzhou, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Oct;49(10):861-3.
To evaluate different methods to explose recurrent laryngeal nerve (RLN) based on the location of thyroid diseses and anatomic path of the RLN, to avoid the RLN damage in thyroid surgery.
A total of 755 cases underwent total lobectomy was studied retrospectively. RLN was explosed in each case.
A total of 963 RLN was exposed in 755 cases, among those 658 RLN were exposed by lateral approach, 106 by inferior approach, and 199 by superior approach. It was showed that 694 RLN traveled deep to the inferior throid artery and 119 superficial to the artery, 98 through between two branches of the artery, and 62 with the cross of the nerve branches and the artery branches. Before entering larynx, 578 RLN gave off branches and 385 had no branches. Non-recurrent laryngeal nerves were found in 2 cases. There were 6 cases who presented with hoarseness after thyroidectomy and undergoing reexploration, among them RLN were legated in 4 cases and severed in 2 cases.
The anatomic relation of RLN is relatively complicated. Lateral, inferior or superior aproach may be used for exposure of RLN to decrease risks of injury to the nerve.
根据甲状腺疾病的位置及喉返神经（RLN）的解剖路径，评估显露喉返神经的不同方法，以避免甲状腺手术中喉返神经损伤。
回顾性研究755例行甲状腺全叶切除术的病例。每例均显露喉返神经。
755例共显露963条喉返神经，其中658条经外侧入路显露，106条经下方入路显露，199条经上方入路显露。结果显示，694条喉返神经走行于甲状腺下动脉深面，119条走行于动脉浅面，98条穿过动脉的两个分支之间，62条与神经分支和动脉分支交叉。在进入喉部之前，578条喉返神经发出分支，385条无分支。发现2例非喉返神经。有6例甲状腺切除术后出现声音嘶哑并接受再次探查，其中4例喉返神经被结扎，2例被切断。
喉返神经的解剖关系相对复杂。可采用外侧、下方或上方入路显露喉返神经，以降低神经损伤风险。
