环甲间隙入路甲状腺手术对喉上神经的识别与保护的意义

摘要

Objective:To look for a good method that can make the exploration of thyroid and protect the external branch of surperior laryngeal nerve easier,in order to avoid postoperative complications,we begin to expose thyroid from the cricothyroid space in thyroid surgery.Method:We used the technique of capsular dissection and performed on 159 consecutive thyroidectomies through a standard approach that was started from the cricothyroid space from September 2013 to July 2014.Result:In all 159 consecutive thyroidectomies,the cricothyroid space was easily created.We used the technique of capsular dissection,superior laryngeal nerve was identified easier.Standard thyroidectomies that were started from the cricothyroid space were performed in all 159 patients.The singal standard thyroidectomy cases were 187(total standard thyroidectomies were performed in 28 cases),the external laryngeal nerves were seen in 158(84.5%) of 187 nerves.The recurrent laryngeal nerves were identified and preserved in all patients,1 patient had a temporary voice change,none of the patients had permanent hypoparathyroidism or low and deep voice or bucking during drink water or recurrent laryngeal nerve palsy.Conclusion:The cricothyroid space is a good guide for thyroidectomy that allows easy and safe exploration of superior laryngeal nerve.%目的：甲状腺手术中从环甲间隙开始暴露甲状腺，探讨寻找新的暴露及保护喉上神经方法，从而避免术后的并发症。方法：2013年9月-2014年7月本科收治的159例甲状腺肿瘤患者，手术全部从环甲间隙开始暴露和解剖甲状腺，从而完成标准的甲状腺腺叶切除。结果：在159例手术患者中，很容易找到环甲间隙，并且从这个间隙开始入路，很容易就可以解剖和保护好喉上神经。159例患者均完成了标准的甲状腺腺叶切除术，其中28例患者行了全甲状腺切除，共行187侧甲状腺腺叶切除，158侧（84.5%）腺叶切除术中看到了喉上神经外侧支，187侧腺叶切除术中均看到了喉返神经，术后除了1例患者可能因术中牵拉而出现了暂时性声音嘶哑外，无其他永久性低钙、声音低沉、饮水呛咳、声嘶等并发症发生。结论：甲状腺手术从环甲间隙开始入路，很容易解剖与保护喉上神经。