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目的:术中观察甲状腺患者的喉返神经和甲状腺下动脉的解剖及其毗邻关系,为指导临床手术操作提供理论依据。方法:对198例甲状腺疾病需行腺叶或全甲状腺切除的患者,术中解剖喉返神经201侧,记录喉返神经与甲状腺下动脉的关系,根据术中喉返神经是否容易损伤将其分为“安全型”和“危险型”两大类。结果:117侧右侧喉返神经与甲状腺下动脉的关系中“安全型”和“危险型”分别为84.6%(99/117)和15.4%(18/117);82侧左侧的“安全型”和“危险型”分别为92.7%(76/82)和7.3%(6/82)。196例共199侧喉返神经由胸腔或右锁骨下动脉返回在甲状腺下及水平后方进入气管食管沟内,沿该沟上行,于环状软骨与甲状软骨下角之间入喉。有2例术中证实为“喉不返神经”,直接自迷走神经水平发出入喉。结论:右侧喉返神经与甲状腺下动脉的关系中“危险型”的发生率高于左侧,术中应特别注意以防损伤喉返神经。
OBJECTIVE: To observe the anatomy and adjacent relationship of the recurrent laryngeal nerve and the inferior thyroid artery in patients with thyroid gland during operation, and provide a theoretical basis for guiding the clinical operation. Methods: 198 cases of thyroid diseases requiring glandular or total thyroidectomy in patients with anatomical recurrent laryngeal nerve 201 side, recording the relationship between recurrent laryngeal nerve and thyroid artery, according to intraoperative recurrent laryngeal nerve is easy to damage its points For the “safe” and “dangerous” two categories. Results: The type of “safe” and “dangerous” type in the relationship between the right laryngeal nerve and the inferior thyroid artery in 117 sides were 84.6% (99/117) and 15.4% (18/117) respectively. The safety Type “and” dangerous type “were 92.7% (76/82) and 7.3% (6/82), respectively. Of the 196 patients, a total of 199 lateral recurrent laryngeal nerves returned through the thoracic or right subclavian artery into the tracheal esophageal groove below and below the thyroid gland, proceeding along the groove and into the larynx between the annular cartilage and the inferior horn of the thyroid cartilage. There are 2 cases of intraoperative confirmed as ”laryngeal nerve“, issued directly from the vagus nerve into the throat. Conclusion: The incidence of ”dangerous type" in the relationship between the right recurrent laryngeal nerve and the inferior thyroid artery is higher than that in the left side. Special attention should be paid to prevent recurrent laryngeal nerve.