内镜辅助甲状腺手术中喉返神经与甲状旁腺的辨别及防护

夏非; 华清泉; 江洋; 管红霞

doi:10.13201/j.issn.1001-1781.2014.12.009

内镜辅助甲状腺手术中喉返神经与甲状旁腺的辨别及防护

- 1. 襄阳市第一人民医院(湖北医药学院附属襄阳医院)耳鼻咽喉头颈外科(湖北襄阳, 441000);
- 2. 武汉大学人民医院耳鼻咽喉头颈外科

详细信息

通讯作者: 华清泉,E-mail:hqqrm@sina.com

中图分类号: R653

收稿日期: 2013-10-20

Identification and protection of recurrent laryngeal nerve and parathyroid glands in endoscopy assisted thyroidectomy

- 1. Department of Otolaryngology Head and Neck Surgery, Xiangyang First People's Hospital, Xiangyang, 441000, China;
- 2. Department of Otolaryngology Head and Neck Surgery, People's Hospital of Wuhan University

More Information

Corresponding author: HUA Qingquan, E-mail: hqqrm@sina.com

Received Date: 20 October 2013

摘要

摘要: 目的：探讨内镜辅助甲状腺手术中的喉返神经与甲状旁腺的辨别及防护。方法：回顾性分析行颈前小切口内镜辅助甲状腺手术32例患者的临床资料，其中甲状腺腺瘤15例，结节性甲状腺肿17例。单侧次全切+峡部切除术22例，双侧叶结节腺瘤对瘤体较大一侧腺体行次全切+峡部切除+对侧腺瘤摘除术10例；术中均对喉返神经及甲状旁腺进行精确辨别及有效保护。结果：术后无甲状腺功能减退、声嘶等并发症，颈部瘢痕美容效果好。结论：腔镜甲状腺手术通过腔镜放大手术视野，结合超声刀和熟练解剖可对甲状旁腺及喉返神经精确辨别，对甲状旁腺及喉返神经行精细解剖可避免术后并发症的发生。
- 腔镜 /
- 超声刀 /
- 甲状腺切除术 /
- 甲状旁腺 /
- 喉返神经
Abstract: Objective: To explore the dissection and protection of recurrent laryngeal nerve and parathyroid glands in endoscopy assisted thyroidectomy.Method: A retrospectively analysis was conducted on 32 patients who have undergone endoscopy assisted thyroidectomy. Postoperative pathology confirmed that 15 cases was thyroid adenoma and 17 cases nodular goiter. Twenty-two cases received subtotal thyroidectomy and isthmusectomy, and the other 10 cases unilateral subtotal thyroidectomy, isthmusectomy and contralateral adenoma resection.Laryngeal recurrent nerve and parathyroid gland were accurately identified and effectively protected during the operation.Result: There were no postoperative complications such as hypothyroidism and hoaroseness, and this surgical procedure have good cosmetic results.Conclusion: With the help of amplification of endoscopy, ultrasonic knife and proficient dissection, endoscopy assisted thyroidectomy could accurately discern recurrent laryngeal nerve and parathyroid glands without postoperative complications.
- endoscope /
- ultrasound knife /
- thyroidectomy /
- parathyroid glands /
- recurrent laryngeal nerve

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参考文献(15)

[1]	黄选兆,汪吉宝,孔维佳.实用耳鼻咽喉头颈外科学[M]. 2版.北京:人民卫生出版社,2008:630-630.
[2]	IKEDA Y, TAKAMI H, NIIMI M,et al.Endoscopic thyroidectomy by the axillary approach[J].Surg Endosc,2001,15:1362-1364.
[3]	王东华,陈蕊,陈满宇.经胸前径路腔镜甲状腺切除术与开放手术的临床比较[J].现代肿瘤医学,2011,19(11):2196-2199.
[4]	艾平,杨翊.完全腔镜与常规开放甲状腺切除术的比较研究[J].当代医学,2010,16(36):112-114.
[5]	GAGNER M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism[J]. Br J Surg, 1996,83:875-875.
[6]	TAN C T, CHEAH W K, DELBRIDGE L."Scarless" (in the neck) endoscopic thyroidectomy (SET):an evidence-based review of published techniques[J].World J Surg,2008,32:1349-1357.
[7]	王存川,段立纪,陈均,等.腔镜下甲状腺部分切除术[J].中国内镜杂志,2002,8(7):19-21.
[8]	CHAN W F, LANG B H, LO C Y.The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy:a comparativestudy on 1000 nerves at risk[J]. Surgery,2006,140:866-872.
[9]	靳小建,卢榜裕,蔡小勇,等.乳晕径路腔镜甲状腺手术的临床应用[J].中国微创外科杂志,2006,6(8):588-589.
[10]	阮剑,龚昭,朱忠超,等.内镜甲状腺手术对甲状旁腺的辨别与保护研究[J].中华腔镜外科杂志(电子版),2011,4(4):261-264.
[11]	屠规益.现代头颈肿瘤外科学[M].北京:科学出版社,2004:639-641.
[12]	彭开勤. 超声刀在甲状腺手术中的应用[J].临床外科杂志,2010,18(7):438-438.
[13]	贺建业,伍冀湘,李华志.经胸骨切迹入路与经胸骨上窝入路腔镜辅助甲状腺手术的比较[J].中国微创外科杂志,2011,11(3):229-232.
[14]	孙辉,刘晓莉,张大奇,等.甲状腺手术中喉返神经保护及监测的临床应用[J].中国普外基础与临床杂志,2010,17(8):768-771.
[15]	范林军,姜军,杨新华,等. ⁹⁹Tc^m-MIBI联合γ探测仪定位甲状旁腺瘤[J]. 第三军医大学学报,2007,29(2):170-172.