Belokonev V I, Pushkin S Yu, Kovaleva Z V, Chemidronov S N, Bezzubov A R, Galstyan N E
Samara State Medical University, Samara, Russia.
Khirurgiia (Mosk). 2022(6):62-71. doi: 10.17116/hirurgia202206162.
To offer the ways for safe thyroidectomy aimed at prevention of damage of recurrent laryngeal nerve in patients with thyroid and parathyroid diseases.
We analyzed postoperative outcomes after thyroidectomy in 342 patients aged 20-80 years. Topography of recurrent laryngeal nerves was studied on 20 laryngeal-tracheal complexes of deceased patients. Technique of visualization of various segments of recurrent laryngeal nerve was worked out.
Thyroidectomy was performed in 342 patients with thyroid and parathyroid diseases. Thyroidectomy was performed in accordance with recommendations described by F.W. Lahey, W.B. Hoover (1938) and H. Malcolm, M.D. Wheeler (1998). Location of recurrent laryngeal nerve varied in patients with nodular, retrosternal goiter and parathyroid gland adenoma. Comparison of intraoperative and morphological data on recurrent laryngeal nerve visualization showed possible risks of its damage during manipulations on thyroid gland, esophagus and trachea. Our study confirmed the need for visualization and mobilization of recurrent laryngeal nerve in all procedures on thyroid and parathyroid glands. Introduction of the described technique of thyroidectomy and training sessions for recurrent laryngeal nerve mobilization on laryngeal-tracheal complexes reduced postoperative incidence of phonation disorders from 21.6% to 0.98%.
Thyroidectomy may be a safe procedure if surgeons are familiar with the details of surgical technique and prevent damage to adjacent structures.
为甲状腺及甲状旁腺疾病患者行甲状腺切除术时预防喉返神经损伤提供安全手术方法。
分析342例年龄在20 - 80岁患者甲状腺切除术后的结果。在20例已故患者的喉气管复合体上研究喉返神经的局部解剖。制定了可视化喉返神经各段的技术。
对342例甲状腺及甲状旁腺疾病患者实施了甲状腺切除术。甲状腺切除术按照F.W.拉希、W.B.胡佛（1938年）以及H.马尔科姆、M.D.惠勒（1998年）描述的建议进行。喉返神经的位置在结节性甲状腺肿、胸骨后甲状腺肿及甲状旁腺腺瘤患者中有所不同。术中与喉返神经可视化形态学数据的比较显示，在甲状腺、食管及气管手术操作过程中存在喉返神经损伤的可能风险。我们的研究证实，在所有甲状腺及甲状旁腺手术中均需对喉返神经进行可视化及游离。采用所述甲状腺切除技术并在喉气管复合体上进行喉返神经游离训练后，术后发声障碍的发生率从21.6%降至0.98%。
如果外科医生熟悉手术技术细节并预防对相邻结构的损伤，甲状腺切除术可以是一种安全的手术。
