[1]李三荣* 刘仁胜 张燕 朱碧荣.腔镜甲状腺手术中喉返神经的显露与保护[J].中国微创外科杂志,2015,15(9):846-848.
　Li Sanrong,Liu Rensheng,Zhang Yan,et al.Exposure and Protection of Recurrent Laryngeal Nerve in Endoscopic Thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2015,15(9):846-848.
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腔镜甲状腺手术中喉返神经的显露与保护()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
15
期数:
2015年9期
页码:
846-848
栏目:
经验交流
出版日期:
2015-09-20

文章信息/Info

Title:
Exposure and Protection of Recurrent Laryngeal Nerve in Endoscopic Thyroidectomy
作者:
李三荣* 刘仁胜 张燕 朱碧荣
（武汉市十一医院甲乳外科，武汉430012）
Author(s):
Li Sanrong;  Liu Rensheng;  Zhang Yan;  et al.
Department of Thyroid and Breast Surgery, Wuhan No. 11 Hospital, Wuhan 430012, China
关键词:
腔镜甲状腺手术; 喉返神经; 手术路径
Keywords:
Laparoscopy thyroid surgery; Recurrent laryngeal nerve; Surgical approach
分类号:
R653
文献标志码:
B
摘要:
目的探讨胸乳入路腔镜甲状腺手术中喉返神经的显露方法以及对喉返神经的保护。方法经胸乳入路行腔镜甲状腺手术，游离腺体采取先内后外、内外结合，先上后下；显露喉返神经采用下极上翘、紧贴腺体、交叉路口由下而上的方法完成甲状腺手术。结果12例顺利完成手术，无中转开放手术。术中共显露喉返神经15条，其中右侧12条。左侧3条。手术时间65~150 min，（110±21）min；术中出血量10~100 ml，（35±22) ml，术后无大出血。术后24 h切口引流量40~120 ml，（80±21) ml。术后未出现声音嘶哑等喉返神经麻痹症状。术后住院时间4~8 d，（5.5±1.2）d。12例术后随访1～12个月，(61±3.1)月，无肿瘤复发，无声音嘶哑等喉返神经麻痹症状。结论腔镜甲状腺手术采用中间入路，即先离断甲状腺峡部的手术路径使腔镜下甲状腺的手术操作更加容易，降低甲状腺手术难度；采用下极上翘、紧贴腺体、交叉路口由下而上的方式显露并保护喉返神经是一种安全的显露方法。
Abstract:
ObjectiveTo investigate the exposure and protection of recurrent laryngeal nerve in endoscopic thyroidectomy via areola upper approach.MethodsThe areola upper approach endoscopic thyroidectomy was carried out. The operation was performed following the principle of “first internal then external, combination of internal and external dessection, and first upper pole then lower pole”. The recurrent laryngeal nerve was exposed by lower pole upturned with close to the gland, and the exposing method was bottomup. ResultsTwelve patients underwent operation successfully, without conversion to open surgery. A total of 15 recurrent laryngeal nerves were exposed, including 12 rightsided and 3 leftsided. The operation time was 65-150 min (mean, 110±21 min) and the operative blood loss was 10-100 ml (mean, 35±22 ml). No postoperative bleeding occurred. At 24 h after operation, the incision drainage was 40-120 ml (mean, 80±21 ml).Postoperatively, no symptoms of recurrent laryngeal nerve paralysis appeared. The average postoperative hospital stay was 4-8 d (mean, 5.5±1.2 d). Postoperative followup was conducted for 1-12 months (mean, 6.1±3.1 months) without recurrence or symptoms of recurrent laryngeal nerve paralysis such as hoarseness.ConclusionEndoscopic thyroidectomy using middle approach, with first cutting isthmus of thyroid, makes the operation more simple and reduces the difficulty of thyroidectomy, which can be used as a safe exposure method of recurrent laryngeal nerve.

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备注/Memo

备注/Memo:
基金项目：武汉市卫生局临床医学科研资助项目（项目编号：WX15C07）*通讯作者，Email：lh200304@sina.com
更新日期/Last Update: 2016-01-04