甲状腺手术区喉返神经及其分支的应用解剖研究

摘要

目的 为甲状腺手术中对喉返神经的定位和保护提供解剖学基础。 方法 解剖50具（100侧）人颈部尸体标本。在甲状腺手术区对喉返神经及其分支进行定位观测。 结果 （1）喉返神经分支按其分布范围可分为喉支和喉外支，前者在入喉前多分为前支、后支。（2）87.0%的喉返神经分支呈树枝状，称树枝型（多支型）；13.0%喉返神经分支与分支或分支与交感神经链间吻合成袢状，称喉返神经袢。（3）59.8%的喉返神经分支发出部位在甲状腺下极平面以上，距甲状腺下极（10.1±7.2）?mm；8.5%的分支发出部位与甲状腺下极相平齐；31.7%在其平面以下，与之距离为（8.6±5.5）mm。（4）右喉返神经50.0%在甲状腺下动脉之前，22.0%在其之后，14.0%在动脉分支之间穿过，14.0%神经分支与动脉分支相互夹持；左喉返神经56.0%在动脉之后，14.0%在其之前，16.0%在动脉分支之间穿过，14.0%神经分支与动脉分支相互夹持。 结论 在甲状腺手术中，结扎甲状腺下动脉前，应仔细分离、单独结扎该动脉，以免损伤喉返神经和（或）其分支。%Objective To provide an anatomic basis for the location andprotection of the branches of the recurrent laryngeal nerve (RLN)and its branches in the thyroid surgery. Methods Fifty adult cadavers (100 sides) fixed with formalin were collected at random for study. The RLN and its branches were dissected, observed and measured in the region of thyroid surgery. Results In the group all RLNs bifurcated into the flaryngeal branch and extra-laryngeal branch. The former usually divided into the anterior branch and posterior branch before entering the larynx. Like a tree, 87% of the RLNs gave off several branches, which were called multiple-branch type. The incidence of RLN loop (loop type), connecting one branch to another and(or) cervical sympathetic chain, was 13.0% (13 out of 100 sides). 59.8% of the branches divided above the level of the inferior pole of the lateral lobe of the thyroid gland, the points where the branches gave off were about (10.1±7.2) mm away from the level of the inferior pole of the thyroid gland, 8.5% of branches divided on the level of the inferior pole of the thyroid gland, and 31.7% of the branches divided under it and the distance was (8.6±5.5) mm. On the right side, the RLN was in front of the inferior thyroid artery in 50% of the cases, behind the artery in 22%; among the branches of the artery in 14%, 14% the branches of both nerves and artery were interlaced that the relationship between the branches of the nerve and the artery was uncertain. On the left side, the RLN was behind the artery in 56%, in front of the artery in 14%. The nerve was between branches in 16%, and was among the combined in 14%. Conclusion To protect RLN from injury in thyroid surgery, it is necessary to separate inferior thyroid artery and its branches from the RLN (or the RLN loop) and its branches before the former are ligated.