“最下途径法”解剖喉返神经在甲状腺手术中的应用
| 作者: |
1赵沨,
1王培斌,
2,3王锡宏,
1姚宝石,
1钟伟,
1许克,
1刘磊,
1陆琪,
1胡秋石,
1李伟,
1梁启弘
1 安徽省淮南市第一人民医院 普通外科，安徽 淮南 232000 2 中国科学技术大学附属第一医院（安徽省立医院） 3 甲乳外科，安徽 合肥 230001 |
| 通讯: |
王培斌
Email: 13855449588@163.com |
| DOI: | 10.3978/.2018.05.011 |
| 基金: | 安徽省淮南市科技计划资助项目（2017B43）。 |
摘要
目的：探讨在甲状腺手术中使用“最下途径法”寻找喉返神经（RLN）临床效果。
方法：回顾性分析2017年12月—2018年4月淮南市第一人民医院22例行甲状腺手术患者的临床资料，患者手术操作过程中以“最下途径法”寻找并解剖RLN，以达到保护及避免损伤的目的。
结果：22例患者手术方式以甲状腺叶切除术为主，其中因甲状腺良性疾病行单侧或双侧甲状腺叶切除术患者17例，因甲状腺恶性肿瘤行甲状腺癌根治术患者5例。所有患者手术中均成功寻找到操作侧RLN（26条），未出现RLN损伤，所有甲状腺手术均安全进行。
结论：“最下途径法”是传统“上、中、下”3种途径显露RLN的手术方法之外的一种新的思路和方法，且标准化、易于重复。尤其是在甲状腺肿大或粘连明显导致周围解剖异常、既往有手术史需再次手术等患者，使用该方法安全、简单且准确率高的，推荐临床使用。
关键词：
甲状腺切除术；喉返神经损伤；手术中并发症
方法：回顾性分析2017年12月—2018年4月淮南市第一人民医院22例行甲状腺手术患者的临床资料，患者手术操作过程中以“最下途径法”寻找并解剖RLN，以达到保护及避免损伤的目的。
结果：22例患者手术方式以甲状腺叶切除术为主，其中因甲状腺良性疾病行单侧或双侧甲状腺叶切除术患者17例，因甲状腺恶性肿瘤行甲状腺癌根治术患者5例。所有患者手术中均成功寻找到操作侧RLN（26条），未出现RLN损伤，所有甲状腺手术均安全进行。
结论：“最下途径法”是传统“上、中、下”3种途径显露RLN的手术方法之外的一种新的思路和方法，且标准化、易于重复。尤其是在甲状腺肿大或粘连明显导致周围解剖异常、既往有手术史需再次手术等患者，使用该方法安全、简单且准确率高的，推荐临床使用。
Application of “the most inferior approach” in dissection of recurrent laryngeal nerve during thyroid surgery
CorrespondingAuthor:WANG Peibin Email: 13855449588@163.com
Abstract
Objective: To investigate the clinical efficacy of using “the most inferior approach” in identification of the recurrent laryngeal nerves (RLNs) during thyroid surgery.
Methods: The clinical data of 22 patients undergoing thyroidectomy in Huainan No.1 People’s Hospital from December 2017 to April 2018 were retrospectively analyzed. All patients underwent identification and dissection of the RLNs through “the most inferior approach” to protect and avoid injury of the RLNs during surgical procedure.
Results: Thyroid lobectomy was the main surgical procedure for the 22 patients, including unilateral or bilateral thyroid lobectomy in 17 cases for benign thyroid diseases, and radical resection in 7 cases for malignant tumor of the thyroid. All the RLNs of the operative sides (26 RLNs) were found during surgery, and no damage of the RLNs occurred in any of the patients. Thyroid surgery was safely performed in all patients.
Conclusion: “The most inferior approach” is the concept of a way and method for exposure of the RLNs besides the conventional “superior, middle and inferior approaches”, and is also standardized and easily reproducible. This method is recommended to be used for its safety, simpleness and high accuracy, especially in patients with anatomical abnormalities caused by thyroid enlargement or severe adhesions, as well as in those with history of thyroid surgery requiring a repeat thyroidectomy.
Keywords：
Thyroidectomy; Recurrent Laryngeal Nerve Injuries; Intraoperative Complications
Methods: The clinical data of 22 patients undergoing thyroidectomy in Huainan No.1 People’s Hospital from December 2017 to April 2018 were retrospectively analyzed. All patients underwent identification and dissection of the RLNs through “the most inferior approach” to protect and avoid injury of the RLNs during surgical procedure.
Results: Thyroid lobectomy was the main surgical procedure for the 22 patients, including unilateral or bilateral thyroid lobectomy in 17 cases for benign thyroid diseases, and radical resection in 7 cases for malignant tumor of the thyroid. All the RLNs of the operative sides (26 RLNs) were found during surgery, and no damage of the RLNs occurred in any of the patients. Thyroid surgery was safely performed in all patients.
Conclusion: “The most inferior approach” is the concept of a way and method for exposure of the RLNs besides the conventional “superior, middle and inferior approaches”, and is also standardized and easily reproducible. This method is recommended to be used for its safety, simpleness and high accuracy, especially in patients with anatomical abnormalities caused by thyroid enlargement or severe adhesions, as well as in those with history of thyroid surgery requiring a repeat thyroidectomy.