甲狀腺手術时喉返神经损伤及其防治.ppt

甲状腺手术时喉返神经损伤及其防治;前 言;Large goiters are prevalent in areas of iodine deficiency. (A). A woman from Switzerland operated upon by Dr. Theodor Kocher (From Kocher T: Zur pathologie und therapie deKropfes (parts I and 2). Dtsch Z Chir 4, 1874 ) (B). One hundred years later, large goiters still occur in many parts of the world, as demonstrated in this woman from a mountainous region of Viet Nam, 1970. ;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;喉返神经损伤发生率 （1）;喉返神经损伤发生率（2）; 一. 喉返神经临床解剖;;;The normal anatomy of the neck in the region of the thyroid gland. (With permission from Halsted WS: The operative story of goiter. Johns Hopkins Hosp Rep 19:71, 1920).;1. 喉返神经的行程 （1）;1. 喉返神经的行程（2）;1. 喉返神经的行程（3）; 喉返神经的行径 ;2. 喉返神经的分支（1）;2. 喉返神经的分支（2）;2. 喉返神经的分支 （3）;2. 喉返神经在喉外分支的高度;3. 喉返神经的变异;非折返性喉返部神经;A) Normal anatomy of the recurrent laryngeal nerve. Note that on the right side the recurrent laryngeal nerve hooks around behind the subclavian artery, while on the left side this nerve passes around behind the aortic arch before ascending in the neck. B) When there is a vascular anomaly of the right subclavian artery, the recurrent laryngeal nerve no longer recurs around this artery but proceeds from the vagus nerve in a more transverse direction to the larynx. In such a situation, the nerve is much more likely to be damaged during operation unless care is taken to visualize its course in the neck.;右侧非返性喉返神经;4. 喉返神经与甲状腺下动脉的关系（1）;1、甲状旁腺2、甲状腺下动脉 分支3、喉返神经 ;4. 喉返神经与甲状腺下动脉的关系（3）;4. 喉返神经与甲状腺下动脉的关系（4）;;;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;;二. 甲状腺手术时喉返神经损伤的常见原因;1. 病理分型;2. 手术术式和次数 ;3. 手术医师年资高低;4. 是否显露喉返神经（1）;甲状腺手术中显露喉返神经对预防喉返神经损伤价值的Meta分析;4. 是否显露喉返神经（2）; 三. 如何寻找喉返神经？（1）;三. 如何寻找喉返神经？（2）;1. 在甲状腺下动脉下方寻找