胸壁入路腔鏡甲狀腺手術中喉返神經的顯露與保護_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 閆開旭 ¹ ,  劉宏斌 ²

1. ;
2. ;

Corresponding?author：

劉宏斌, Email: liuhongbin999@163.com

Keywords：

喉返神經; 顯露; 保護; 腔鏡甲狀腺手術; 超聲刀

DOI：

10.7507/1007-9424.20160381

Video：

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目的探討胸壁入路腔鏡甲狀腺手術中喉返神經顯露的技巧，預防喉返神經醫源性損傷。方法回顧性收集2013年8月至2014年12月期間于蘭州軍區蘭州總醫院行胸壁入路腔鏡甲狀腺手術的45例患者的臨床資料。手術時利用甲狀腺下動脈、氣管食管溝及甲狀軟骨下角顯露喉返神經。結果 45例患者中，行單側腺葉大部切除18例，行單側腺葉切除22例，行雙側腺葉大部切除5例；手術時間108~125 min、（120±7）min，術中出血量18~25 mL、（23±4）mL。術后均無不適，無并發癥發生。術后所有患者均獲訪，隨訪時間6~12個月，平均9個月。隨訪期間出現甲狀腺功能減退2例，其余均正常，且2例甲狀腺乳頭狀癌患者均未復發。結論術中顯露喉返神經有利于避免喉返神經損傷。

Citation： 閆開旭, 劉宏斌. 胸壁入路腔鏡甲狀腺手術中喉返神經的顯露與保護. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1510-1512. doi: 10.7507/1007-9424.20160381 Copy

1.	Radford PD, Ferguson MS, Magill JC, et al. Meta-analysis of minimally invasive video-assisted thyroidectomy. Laryngoscope, 2011, 121(8):1675-1681.
2.	崔進軍, 宗林.腔鏡輔助下小切口甲狀腺切除術.中國微創外科雜志, 2013, 13(4):379-380.
3.	Iacobone M, Viel G, Zanella S, et al. The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery. Langenbecks Arch Surg, 2008, 393(5):633-638.
4.	孫輝.甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版).中國實用外科雜志, 2014, 34(6):470-474.
5.	孫輝, 劉曉莉.甲狀腺手術中喉返神經和喉上神經的保護.中國實用外科雜志, 2015, 32(5):356-359.
6.	呂斌, 陳波, 李魯傳, 等.術中神經監測在甲狀腺再次手術中的應用.中華普通外科雜志, 2013, 27(8):669-670.
7.	Levin KE, Clark AH, Duh QY, et al. Reoperative thyroid surgery. Surgery, 1992, 111(6):604-609.
8.	徐偉, 唐平章, 李正江.甲狀腺癌局部切除術后再手術的探討.中華腫瘤雜志, 2012, 24(2):185-187.
9.	李友西, 劉衛國, 張建立.腔鏡甲狀腺手術術后并發癥的臨床分析.腹腔鏡外科雜志, 2014, 19(4):275-277.
10.	Maeda S, Shimizu K, Minami S, et al. Video-assisted neck surgery for thyroid and parathyroid diseases. Biomed Pharmacother, 2002, 56 Suppl 1:92s-95s.
11.	Owaki T, Nakano S, Arimura K, et al. The ultrasonic coagulating and cutting system injures nerve function. Endoscopy, 2002, 34(7):575-579.
12.	Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg, 1996, 83(6):875.
13.	Huscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endoscopic, 1997, 11(8):877.
14.	唐輝蓉, 張建先, 廖陳, 等.經胸乳入路腔鏡甲狀腺手術應用與優勢.中華腔鏡外科雜志:電子版, 2014, 4(2):139-143.
15.	McCombe A. Re:O'Neill JP, Fenton JE. The recurrent laryngeal nerve in thyroid surgery. Surgeon 20086; 6:373-7. Surgeon, 2009, 7(3):187-188.
16.	Kandil E, Wassef SN, Alabbas H, et al. Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring. Int J Otolaryngol, 2009, 2009:739798.
17.	Lu JH, Materazzi G, Miccoli M, et al. Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach:a retrospective analysis of safety, postoperative recovery, and patient satisfaction. Minerva Chir, 2012, 67(1):31-37.
18.	李進義, 王存川, 潘運龍, 等.腔鏡甲狀腺手術中喉返神經損傷預防.中國實用外科雜志, 2014, 27(9):711-712.
19.	Canbaz H, Dirlik M, Colak T, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve. J Zhejiang Univ Sci B, 2008, 9(6):482-488.
20.	邱正倫, 馮云, 李振宇.甲狀腺手術中常規顯露喉返神經320例分析.中國誤診學雜志, 2014, 12(11):2681-2682.
21.	Ardito G, Revelli L, D'Alatri L, et al. Revisited anatomy of the recurrent laryngeal nerves. Am J Surg, 2004, 187(2):249-253.

1. Radford PD, Ferguson MS, Magill JC, et al. Meta-analysis of minimally invasive video-assisted thyroidectomy. Laryngoscope, 2011, 121(8):1675-1681.
2. 崔進軍, 宗林.腔鏡輔助下小切口甲狀腺切除術.中國微創外科雜志, 2013, 13(4):379-380.
3. Iacobone M, Viel G, Zanella S, et al. The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery. Langenbecks Arch Surg, 2008, 393(5):633-638.
4. 孫輝.甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版).中國實用外科雜志, 2014, 34(6):470-474.
5. 孫輝, 劉曉莉.甲狀腺手術中喉返神經和喉上神經的保護.中國實用外科雜志, 2015, 32(5):356-359.
6. 呂斌, 陳波, 李魯傳, 等.術中神經監測在甲狀腺再次手術中的應用.中華普通外科雜志, 2013, 27(8):669-670.
7. Levin KE, Clark AH, Duh QY, et al. Reoperative thyroid surgery. Surgery, 1992, 111(6):604-609.
8. 徐偉, 唐平章, 李正江.甲狀腺癌局部切除術后再手術的探討.中華腫瘤雜志, 2012, 24(2):185-187.
9. 李友西, 劉衛國, 張建立.腔鏡甲狀腺手術術后并發癥的臨床分析.腹腔鏡外科雜志, 2014, 19(4):275-277.
10. Maeda S, Shimizu K, Minami S, et al. Video-assisted neck surgery for thyroid and parathyroid diseases. Biomed Pharmacother, 2002, 56 Suppl 1:92s-95s.
11. Owaki T, Nakano S, Arimura K, et al. The ultrasonic coagulating and cutting system injures nerve function. Endoscopy, 2002, 34(7):575-579.
12. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg, 1996, 83(6):875.
13. Huscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endoscopic, 1997, 11(8):877.
14. 唐輝蓉, 張建先, 廖陳, 等.經胸乳入路腔鏡甲狀腺手術應用與優勢.中華腔鏡外科雜志:電子版, 2014, 4(2):139-143.
15. McCombe A. Re:O'Neill JP, Fenton JE. The recurrent laryngeal nerve in thyroid surgery. Surgeon 20086; 6:373-7. Surgeon, 2009, 7(3):187-188.
16. Kandil E, Wassef SN, Alabbas H, et al. Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring. Int J Otolaryngol, 2009, 2009:739798.
17. Lu JH, Materazzi G, Miccoli M, et al. Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach:a retrospective analysis of safety, postoperative recovery, and patient satisfaction. Minerva Chir, 2012, 67(1):31-37.
18. 李進義, 王存川, 潘運龍, 等.腔鏡甲狀腺手術中喉返神經損傷預防.中國實用外科雜志, 2014, 27(9):711-712.
19. Canbaz H, Dirlik M, Colak T, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve. J Zhejiang Univ Sci B, 2008, 9(6):482-488.
20. 邱正倫, 馮云, 李振宇.甲狀腺手術中常規顯露喉返神經320例分析.中國誤診學雜志, 2014, 12(11):2681-2682.
21. Ardito G, Revelli L, D'Alatri L, et al. Revisited anatomy of the recurrent laryngeal nerves. Am J Surg, 2004, 187(2):249-253.

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胸壁入路腔鏡甲狀腺手術中喉返神經的顯露與保護

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