中国实用外科杂志

中国实用外科杂志

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非返性喉返神经解剖特征及术中保护策略（附22例报告）

柳麓崙，王培松，王    硕，薛    帅，陈    光   

  1. 吉林大学第一医院甲状腺外科，吉林长春 130021
  • 出版日期:2016-08-01 发布日期:2016-07-27

  • Online:2016-08-01 Published:2016-07-27

摘要：

目的    探讨非返性喉返神经（NRLN）的变异规律及处理经验。方法    回顾性分析吉林大学第一医院甲状腺外科同一医疗组2009年1月至2015年12月实施的5900例甲状腺及甲状旁腺手术病例资料，其中22例术中发现NRLN。结果    5900例甲状腺及甲状旁腺手术共显露喉返神经8850条，其中右侧4451条，左侧4399条；共发现非返性喉返神经22条，全部位于右侧，发生率为0.5%（22/4451）；其中Ⅰ型4条、2A型10条，2B型8条。NRLN发生与性别、甲状腺肿瘤性质、甲状腺或者甲状旁腺手术、神经监测仪应用等均无相关性。喉返神经监测病人中3例NRLN显露时间为（4.2±1.8）min，常规显露病人中19例NRLN显露时间为（9.7±2.1）min，二者差异有统计学意义（P<0.05）。22条NRLN无一损伤。结论    NRLN临床少见，以右侧居多；熟悉解剖特征、提高对NRLN认识、术中精细解剖及喉返神经常规显露是预防NRLN损伤的关键。

关键词: 甲状腺切除术, 非返性喉返神经, 喉返神经

Abstract:

Anatomy characteristics and intraoperative protection of non recurrent laryngeal nerve：22 cases experience sharing        LIU Lu-lun，WANG Pei-song，WANG Shuo，et al. Department of Thyroid Surgery，the First Hospital of Jilin University，Changchun 130021，China
Corresponding author：WANG Pei-song，E-mail:wangpeisong1982@163.com
Abstract    Objective    To investigate the non recurrent laryngeal nerve(NRLN) variation. Methods    22 cases of patients with NRLN were detected and retrospectively analyzed in 5900 cases of patients who underwent thyroid or parathyroid surgery from our division by the same medical group between January 2009 and December 2015. Results    A total of 8850 recurrent laryngeal nerve(RLN) were exposed in 5900 cases of thyroid and parathyroid surgery，in which 4451 cases located on the right side ,4399 cases located on the left side.22 cases of patients with NRLN were detected，all located on the right side，with a incidence of 0.49% (22/4451).There were 4 cases of type 1,10 cases of type 2A,8 cases of type 2B.There was no correlation between NRLN and sex，the nature of thyroid tumors，thyroid or parathyroid surgery，nerve monitor application etc. Exposure time was 4.2±1.8 min for 3 cases of NRLN in recurrent laryngeal nerve monitoring group, in comparison exposure time was 9.7±2.1 min for 19 cases of NRLN in conventional nerve exposure group，P=0.0004. Recurrent laryngeal nerve monitoring can significantly shorten the NRLN exposure time.No one was injured for all the 22 cases of NRLN. Conclusion    The incidence of NRLN is low，most of which occur on the right side of neck；Familiar with the anatomical features, improving awareness of NRLN, fining dissection and conventional exposure recurrent laryngeal nerve is the key to prevent nerve injury.

Key words: thyroidectomy, non recurrent laryngeal nerve, recurrent laryngeal nerve