Objective To explore skills and injury prevention methods of exposing recurrent laryngeal nerve in endoscopic thyroidectomy . Methods The endoscopic thyroidectomy via areola approach was performed in 46 cases in our hospital from October 2014 to October 2015.During the operation, skills and injury prevention methods of exposing recurrent laryngeal nerve included keeping clear surgical vision , appropriate application of ultrasound knife , and saline gauze coverage . Results The endoscopic thyroidectomy was completed successfully in all the 46 cases without conversion to open surgery .The recurrent laryngeal nerves were exposed in 45 cases, while were not found in 1 case ( no postoperative hoarseness occurred and nonrecurrent laryngeal nerve was possible).The operation time was 45-145 min (110 ±20 min) and the operative blood loss was 15 -95 ml (35 ±18 ml).No postoperative bleeding occurred .The incision drainage volume at 24 h after operation was 35-125 ml (80 ±22 ml).Postoperative hospital stay was 3-8 d (5.4 ±1.2 d).Postoperative pathological examinations showed 14 cases of thyroid adenoma, 21 cases of nodular goiter , and 11 cases of micro-lesions of papillary carcinoma .One patient had transient hoarseness , which was self-healed within three months . Conclusion The recurrent laryngeal nerve injury can be prevented by taking comprehensive measures in endoscopic thyroid surgery .%目的：探讨腔镜甲状腺腺叶切除手术中喉返神经的保护技巧。方法我院2014年10月～2015年10月行腔镜甲状腺腺叶切除术46例，术中通过保持术野清晰，合理应用超声刀，盐水纱条应用等措施保护喉返神经。结果46例手术均获得成功，45例术中显露喉返神经，1例未成功显露（术后无声音嘶哑症状，怀疑喉不返神经可能）。手术时间45～145 min，（110±20） min；术中出血量15～95 ml，（35±18） ml，术后无大出血。术后24 h切口引流量35～125 ml，（80±22）ml。术后住院时间3～8 d，（5．4±1．2）d。术后病理：甲状腺腺瘤14例，结节性甲状腺肿21例，微灶乳头状癌11例。1例出现暂时性声音嘶哑，3个月内自行恢复。结论腔镜甲状腺腺叶切除手术中通过采取综合措施，可预防喉返神经损伤。
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