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背景与目的:目前临床对甲状腺肿瘤手术是否常规显露喉返神经仍存在争议,我们探讨术中解剖喉返神经的方法及其利弊。方法:对手术治疗的甲状腺肿瘤患者456例进行回顾性分析,266例手术常规显露喉返神经,190例手术常规不显露喉返神经,采用解剖区域保护法行甲状腺次全切除术。结果:解剖喉返神经术式组无喉返神经损伤,不显露喉返神经术式者喉返神经损伤4例(暂时性喉返神经损伤3例,永久性喉返神经损伤1例)占2.1%。暂时性喉返神经损伤3例,其中1例因一侧肿瘤较大,2例因结节性甲状腺肿位于甲状腺后背侧造成损伤,永久性喉返神经损伤1例为肿瘤复发再次手术。结论:熟悉喉返神经的解剖和变异,行甲状腺切除术时解剖显露喉返神经可以降低喉返神经损伤的发生率。
BACKGROUND & OBJECTIVE: It is still controversial whether the thyroid neoplasm is routinely exposed to the recurrent laryngeal nerve in clinical practice. We discuss the methods of dissecting the recurrent laryngeal nerve and its advantages and disadvantages. Methods: A retrospective analysis was performed on 456 cases of thyroid tumors undergoing surgery. 266 cases of recurrent laryngeal nerve were routinely revealed, while 190 cases of recurrent laryngeal nerve were not routinely exposed. Subtotal thyroidectomy was performed by anatomic regional protection. Results: There were no recurrent laryngeal nerve injury in recurrent laryngectomy group, 4 recurrent laryngeal nerve injuries (3 cases of temporary recurrent laryngeal nerve injury and 1 case of permanent recurrent laryngeal nerve injury) accounted for 2.1% %. There were 3 cases of temporary recurrent laryngeal nerve injury, of which 1 case had a larger tumor on one side, 2 cases had nodular goiter located behind the thyroid gland, and 1 case had permanent recurrent laryngeal nerve injury. Conclusion: Familiar with the anatomy and variation of the recurrent laryngeal nerve, anatomical exposure of the recurrent laryngeal nerve during thyroidectomy can reduce the incidence of recurrent laryngeal nerve injury.