Lennquist S, Cahlin C, Smeds S
Department of Surgery, University Hospital, Linköping, Sweden.
Surgery. 1987 Dec;102(6):999-1008.
Injury to the external branch of the superior laryngeal nerve (ESLN) during thyroid surgery can have serious consequences. A strategy for perioperative identification and preservation of the ESLN was clinically evaluated after postmortem anatomic observations. These showed that 20% of ESLNs run distally through the pharyngeal constrictor muscle, which necessitates intramuscular dissection for identification in the area around the superior thyroid pole. In 23% of the ESLNs identifiable without intramuscular dissection (18% of the total), a course partly lateral to the superior thyroid artery and its branches implied definite risk of injury during division of the superior pole vessels. In the clinical series, 72% of the ESLNs were identifiable without intramuscular dissection, and 19% of these (14% of the total) were partly lateral to the superior thyroid artery. Only one patient had signs of ESLN injury postoperatively, probably caused by diathermy to an adjacent vessel. Perioperative identification of ESLN with dissection into the pharyngeal constrictor muscle (about 20% of cases) appears to be inadvisable, but identification of ESLN with other courses is important, as around 20% are highly vulnerable during division of the superior thyroid artery and its branches.
甲状腺手术中喉上神经外支（ESLN）损伤可产生严重后果。在尸体解剖观察后，对围手术期识别和保留ESLN的策略进行了临床评估。结果显示，20%的ESLN向远侧走行穿过咽缩肌，因此在甲状腺上极周围区域识别时需要进行肌内解剖。在无需肌内解剖即可识别的ESLN中（占总数的18%），23%的走行部分位于甲状腺上动脉及其分支的外侧，这意味着在分离上极血管时存在明确的损伤风险。在临床系列中，72%的ESLN无需肌内解剖即可识别，其中19%（占总数的14%）部分位于甲状腺上动脉外侧。术后仅1例患者出现ESLN损伤体征，可能是由于对邻近血管进行电凝所致。对约20%的病例进行肌内解剖以围手术期识别ESLN似乎不可取，但识别走行不同的ESLN很重要，因为约20%的ESLN在甲状腺上动脉及其分支分离过程中极易受损。
