摘要目的：探讨甲状腺手术中喉返神经(RLN)、喉上神经(SLN)的保护方法,以避免或减少术后永久性神经损伤的发生率。方法对东南大学医学院附属南京同仁医院耳鼻咽喉头颈外科,2013年6月—2014年11月行甲状腺精细化操作手术治疗141例患者的临床资料进行回顾性分析。其中男37例、女104例,年龄9~78岁。行甲状腺全切54例,甲状腺腺叶切除58例,甲状腺腺叶切除+对侧部分切除29例；其中二次手术者10例,行Ⅵ区清扫者18例。术中 RLN 显露者121例,未显露者20例。结果本组141例均顺利完成手术。术后并发 RLN 暂时性损伤5侧,占2.56%(5/195),给予激素、神经营养药物治疗,并配合发音训练,3个月内神经功能均恢复正常；其中 RLN 显露组占2.5%(3/121),未显露组占5%(1/20),组间比较差异无统计学意义(χ2=0.396, P >0.05)。无一例并发 RLN 永久性损伤和 SLN 损伤。结论熟悉 RLN、SLN 与甲状腺的正常解剖与变异情况,应用被膜解剖技术精细操作,术后可以避免神经的永久性损伤。一旦发生神经损伤,及时给予对症处理,提高患者的生活质量。

abstractsObjective To investigate how to correctly protect the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve( SLN) in the thyroidectomy, to avoid and reduce permanent neurologic injury postoperation. Methods One hundred and forty-one cases who underwent thyroidectomy (37 male, 104 female, aged 9 - 78) were retrospectively analyzed from June 2013 to Nov. 2014 in Nanjing Tongren Hospital, including total thyroidwctomy (54 patiens), lobectomy (58 patiens), thyroid lobectomy with contralateral partial thyroidectomy (29 patiens), among them, 10 cases of secondary surgery, and Ⅵ area lymph nodes cleaning 18 patiens. Intraoperative RLN revealed 121 patiens, 20 patients did not show. Results All 141 patients were successfully completed surgery. The RLN transitory injury was occurred in 5 sides (2. 56% , 5 / 195), All the nerve function recover within 3 months postoperation after hormones, nurotrophic drug therapy, and cooperate with the pronunciation training. There were no RLN permanent damage and the SLN injury. Conclusions The permanent damage of nerve can be prevented by being familiar with anatomic variation of the RLN,SLN and thyroid, meticulous operation with membrane dissection technology . In the event of nerve damage, a timely manner to give symptomatic treatment can improve the patient`s quality of life.