胸壁入路腔镜甲状腺手术中喉返神经的显露与保护_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 闫开旭 ¹ ,  刘宏斌 ²

1. ;
2. ;

Corresponding author：

刘宏斌, Email: liuhongbin999@163.com

Keywords：

喉返神经; 显露; 保护; 腔镜甲状腺手术; 超声刀

DOI：

10.7507/1007-9424.20160381

Video：

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目的探讨胸壁入路腔镜甲状腺手术中喉返神经显露的技巧，预防喉返神经医源性损伤。方法回顾性收集2013年8月至2014年12月期间于兰州军区兰州总医院行胸壁入路腔镜甲状腺手术的45例患者的临床资料。手术时利用甲状腺下动脉、气管食管沟及甲状软骨下角显露喉返神经。结果 45例患者中，行单侧腺叶大部切除18例，行单侧腺叶切除22例，行双侧腺叶大部切除5例；手术时间108~125 min、（120±7）min，术中出血量18~25 mL、（23±4）mL。术后均无不适，无并发症发生。术后所有患者均获访，随访时间6~12个月，平均9个月。随访期间出现甲状腺功能减退2例，其余均正常，且2例甲状腺乳头状癌患者均未复发。结论术中显露喉返神经有利于避免喉返神经损伤。

Citation： 闫开旭, 刘宏斌. 胸壁入路腔镜甲状腺手术中喉返神经的显露与保护. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1510-1512. doi: 10.7507/1007-9424.20160381 Copy

1.	Radford PD, Ferguson MS, Magill JC, et al. Meta-analysis of minimally invasive video-assisted thyroidectomy. Laryngoscope, 2011, 121(8):1675-1681.
2.	崔进军, 宗林.腔镜辅助下小切口甲状腺切除术.中国微创外科杂志, 2013, 13(4):379-380.
3.	Iacobone M, Viel G, Zanella S, et al. The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery. Langenbecks Arch Surg, 2008, 393(5):633-638.
4.	孙辉.甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版).中国实用外科杂志, 2014, 34(6):470-474.
5.	孙辉, 刘晓莉.甲状腺手术中喉返神经和喉上神经的保护.中国实用外科杂志, 2015, 32(5):356-359.
6.	吕斌, 陈波, 李鲁传, 等.术中神经监测在甲状腺再次手术中的应用.中华普通外科杂志, 2013, 27(8):669-670.
7.	Levin KE, Clark AH, Duh QY, et al. Reoperative thyroid surgery. Surgery, 1992, 111(6):604-609.
8.	徐伟, 唐平章, 李正江.甲状腺癌局部切除术后再手术的探讨.中华肿瘤杂志, 2012, 24(2):185-187.
9.	李友西, 刘卫国, 张建立.腔镜甲状腺手术术后并发症的临床分析.腹腔镜外科杂志, 2014, 19(4):275-277.
10.	Maeda S, Shimizu K, Minami S, et al. Video-assisted neck surgery for thyroid and parathyroid diseases. Biomed Pharmacother, 2002, 56 Suppl 1:92s-95s.
11.	Owaki T, Nakano S, Arimura K, et al. The ultrasonic coagulating and cutting system injures nerve function. Endoscopy, 2002, 34(7):575-579.
12.	Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg, 1996, 83(6):875.
13.	Huscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endoscopic, 1997, 11(8):877.
14.	唐辉蓉, 张建先, 廖陈, 等.经胸乳入路腔镜甲状腺手术应用与优势.中华腔镜外科杂志:电子版, 2014, 4(2):139-143.
15.	McCombe A. Re:O'Neill JP, Fenton JE. The recurrent laryngeal nerve in thyroid surgery. Surgeon 20086; 6:373-7. Surgeon, 2009, 7(3):187-188.
16.	Kandil E, Wassef SN, Alabbas H, et al. Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring. Int J Otolaryngol, 2009, 2009:739798.
17.	Lu JH, Materazzi G, Miccoli M, et al. Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach:a retrospective analysis of safety, postoperative recovery, and patient satisfaction. Minerva Chir, 2012, 67(1):31-37.
18.	李进义, 王存川, 潘运龙, 等.腔镜甲状腺手术中喉返神经损伤预防.中国实用外科杂志, 2014, 27(9):711-712.
19.	Canbaz H, Dirlik M, Colak T, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve. J Zhejiang Univ Sci B, 2008, 9(6):482-488.
20.	邱正伦, 冯云, 李振宇.甲状腺手术中常规显露喉返神经320例分析.中国误诊学杂志, 2014, 12(11):2681-2682.
21.	Ardito G, Revelli L, D'Alatri L, et al. Revisited anatomy of the recurrent laryngeal nerves. Am J Surg, 2004, 187(2):249-253.

1. Radford PD, Ferguson MS, Magill JC, et al. Meta-analysis of minimally invasive video-assisted thyroidectomy. Laryngoscope, 2011, 121(8):1675-1681.
2. 崔进军, 宗林.腔镜辅助下小切口甲状腺切除术.中国微创外科杂志, 2013, 13(4):379-380.
3. Iacobone M, Viel G, Zanella S, et al. The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery. Langenbecks Arch Surg, 2008, 393(5):633-638.
4. 孙辉.甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版).中国实用外科杂志, 2014, 34(6):470-474.
5. 孙辉, 刘晓莉.甲状腺手术中喉返神经和喉上神经的保护.中国实用外科杂志, 2015, 32(5):356-359.
6. 吕斌, 陈波, 李鲁传, 等.术中神经监测在甲状腺再次手术中的应用.中华普通外科杂志, 2013, 27(8):669-670.
7. Levin KE, Clark AH, Duh QY, et al. Reoperative thyroid surgery. Surgery, 1992, 111(6):604-609.
8. 徐伟, 唐平章, 李正江.甲状腺癌局部切除术后再手术的探讨.中华肿瘤杂志, 2012, 24(2):185-187.
9. 李友西, 刘卫国, 张建立.腔镜甲状腺手术术后并发症的临床分析.腹腔镜外科杂志, 2014, 19(4):275-277.
10. Maeda S, Shimizu K, Minami S, et al. Video-assisted neck surgery for thyroid and parathyroid diseases. Biomed Pharmacother, 2002, 56 Suppl 1:92s-95s.
11. Owaki T, Nakano S, Arimura K, et al. The ultrasonic coagulating and cutting system injures nerve function. Endoscopy, 2002, 34(7):575-579.
12. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg, 1996, 83(6):875.
13. Huscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endoscopic, 1997, 11(8):877.
14. 唐辉蓉, 张建先, 廖陈, 等.经胸乳入路腔镜甲状腺手术应用与优势.中华腔镜外科杂志:电子版, 2014, 4(2):139-143.
15. McCombe A. Re:O'Neill JP, Fenton JE. The recurrent laryngeal nerve in thyroid surgery. Surgeon 20086; 6:373-7. Surgeon, 2009, 7(3):187-188.
16. Kandil E, Wassef SN, Alabbas H, et al. Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring. Int J Otolaryngol, 2009, 2009:739798.
17. Lu JH, Materazzi G, Miccoli M, et al. Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach:a retrospective analysis of safety, postoperative recovery, and patient satisfaction. Minerva Chir, 2012, 67(1):31-37.
18. 李进义, 王存川, 潘运龙, 等.腔镜甲状腺手术中喉返神经损伤预防.中国实用外科杂志, 2014, 27(9):711-712.
19. Canbaz H, Dirlik M, Colak T, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve. J Zhejiang Univ Sci B, 2008, 9(6):482-488.
20. 邱正伦, 冯云, 李振宇.甲状腺手术中常规显露喉返神经320例分析.中国误诊学杂志, 2014, 12(11):2681-2682.
21. Ardito G, Revelli L, D'Alatri L, et al. Revisited anatomy of the recurrent laryngeal nerves. Am J Surg, 2004, 187(2):249-253.

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胸壁入路腔镜甲状腺手术中喉返神经的显露与保护

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