常规显露喉返神经在降低喉返神经损伤中作用探究.docVIP

常规显露喉返神经在降低喉返神经损伤中作用探究 　【摘要】 目的 研究开放性甲状腺手术中显露喉返神经在预防喉返神经损伤中的作用。方法 对手术治疗的319例甲状腺病变进行回顾性分析，其中，186例手术常规显露喉返神经，另133例采用解剖区域保护法行甲状腺部分或次全切除术，不显露喉返神经。结果 显露喉返神经术式组中，喉返神经损伤1例，占0.54%，而非显露喉返神经术式组6例，占4.51%。其中，暂时性喉返神经损伤5例，永久性喉返神经损伤1例。结论 熟悉喉返神经的解剖和变异，在开放性甲状腺手术中显露喉返神经可降低喉返神经损伤的发生率。 【关键词】 喉返神经 甲状腺手术 损伤 Application of exposure of recurrent laryngeal nerve in decreasing injury of recurrent laryngeal nerve in open thyroid surgery ［Abstract］ Objective To discuss the significance of exposing the recurrent laryngeal nerve (RLN) in prevention of RLN injury for open thyroid surgery.Methods 319 cases of thyroid tumour who were operated were reviewed.In 186 cases，RLN was unveiled generally.133 cases had partial or subtotal thyroiddectomy with locality protection of anatomic region.Results 1 case of RLN injury occurred in the exposure group.6 cases occurred in non-exposure group（5 cases of temporary RLN injury and 1 case of permanent RLN injury）.Among the 5 cases of temporary RLN injury，one was caused by over dragging during surgery，two were caused by the large size of thyroid tumour，the other two were caused by the location of thyroid tumor.One case of permanent RLN injury was a case of cutting off RLN.Conclusion The familiarity of the anatomy and variation of RLN，and the exposure of RLN in thyroid surgery，can reduce the rate of the RLN injury. ［Key words］ recurrent laryngeal nerve;thyroid surgery;injury 喉返神经损伤是甲状腺手术引起的严重并发症之一。患者一侧喉返神经损伤可引起声嘶，饮水呛咳，双侧喉返神经损伤可引起呼吸困难，甚至窒息死亡。尽管术中采用各种预防措施，但甲状腺手术中喉返神经的损伤仍时有发生。据国外文献报道，喉返神经损伤的发生率差异较大，在开放性甲状腺手术，喉返神经损伤总发生率为2%～17%［1］。如何避免喉返神经损伤，仍然是外科医师一直关注的问题［2］。现回顾性分析我院319例甲状腺手术，探讨开放性甲状腺手术中显露喉返神经在预防喉返神经损伤中的作用。 1 资料与方法 1.1 一般资料 收集1997年1月～2007年5月上海市南汇区中心医院甲状腺手术319例，其中男95例，女224例，年龄13～85岁，中位年龄43岁，左侧甲状腺129例，右侧146例，双侧44例。全部病例术前均行甲状腺B超检查，甲状腺囊性占位17例，囊实性占位168例，实质性占位134例。术前行CT扫描者210例，术前均常规行间接喉镜检查。 1.2 麻醉和术式的选择 319例甲状腺病变均采取开放性手术治疗。其中，显露喉返神经组颈丛神经阻滞麻醉86例，全身麻醉100例，次全切除或部分切除术77例，一侧甲状腺叶全切除术87例，一侧腺叶+峡部切除术4例，一侧甲状腺腺叶+峡部+对侧次全切+Ⅵ区淋巴结清扫术12例，一侧功能性颈淋巴结清扫术4例，改良式颈淋巴结清扫术2例。非显露喉返神经组颈丛阻滞麻醉6