目的 探讨暴露喉返神经的甲状腺手术后患者发生声音嘶哑的原因。方法 选取于2019年1月—2020年12月间在我院接受甲状腺手术且在术中暴露喉返神经的患者,对出现术后声音嘶哑的19例患者进行为期12个月的临床随访,观察研究对象术后声音嘶哑的发生特点、持续时间并进行直接喉镜及颈部超声检查。结果 发生声音嘶哑的19例患者中,5例存在术中喉返神经损伤情况,其余14例患者术中喉返神经暴露及保护良好。直接喉镜检查示,该14例患者中,4例存在声带充血水肿现象,1例发生勺状软骨半脱位。术后1周左右的超声检查显示,该14例患者中有11例存在不同程度的创腔内积液。结论 虽常规暴露喉返神经减少了术后声嘶的发生率,但术中喉返神经损伤仍然是造成患者术后声嘶的原因之一。此外,术后创腔积液、麻醉插管导致的声带损伤及其他插管相关并发症等非直接手术因素也是造成这些患者术后声嘶的重要原因,应引起临床重视。

Objective To explore the cause of hoarseness of voice in patients after thyroidectomy with recurrent laryngeal nerve exposure. Methods The patients from January 2019 to December 2020 underwent thyroidectomy with exposure of recurrent laryngeal nerve during operation were selected. There were 19 cases of hoarseness of voice after operation followed up for 12 months. Postoperative observations included the characteristics of the hoarseness of voice, duration, and direct laryngoscope neck ultrasonography. Results A total of 19 patients had voice hoarseness, only 5 of them had recurrent laryngeal nerve injury during operation, the other 14 patients had good exposure and protection of recurrent laryngeal nerve. Direct laryngoscope showed that 4 of 14 patients had vocal cord edema and 1 had subluxation of arytenoid cartilage. About 1 week after operation, ultrasound examination showed that 11 of 14 patients had varying degrees hydrops of wound cavity. Conclusions Although the routine exposure of recurrent laryngeal nerve reduces the incidence of postoperative hoarseness of voice, the injury of recurrent laryngeal nerve is still a cause of postoperative hoarseness of voice. In addition, non-operative direct factors, such as fluid accumulation in the operative field, vocal cord injury caused by anesthetic intubation and other intubation related complications, are also important reasons for postoperative hoarseness of voice in these patients, which we should pay more attention to.

目的 为避免和减少颈部手术对喉返神经损伤,本文利用尸体解剖探讨喉返神经走向与分布以及与周围组织的相关性。方法 将20具用甲醛固定的成年尸体标本喉返神经(40侧)及其分支解剖;肉眼观察其与甲状腺、甲状腺下动脉和Berry's韧带相关性;测量喉返神经入喉点与甲状软骨下角的距离,以及甲状软骨下角至锁骨中点与胸骨柄上端的距离。结果 喉返神经与甲状腺下动脉交叉比例为96%,交叉点在甲状腺下极平面之上占88%,喉返神经位于甲状腺下动脉及其分支的前方与后方分别为22%与50%,经过Berry's韧带后方占95%,喉返神经入喉点至甲状软骨下角的距离(8.2±2.5)mm。结论 喉返神经与甲状腺下动脉和甲状腺韧带关系复杂,甲状软骨下角可作为喉返神经定位标志。

Objective In an attempt to reduce the risk of intraoperative recurrent laryngeal nerve (RLN) damage, human autopsy was conducted to determine the distribution of RLN and its relationship with surroundings. Methods With the naked eye observation, 20 formalin-fixed adult cadavers were examined. The relationships between RLN and inferior thyroid artery and inferior horn of thyroid cartilage were defined. Both the distance between entering point and inferior horn of thyroid cartilage and the distance between inferior horn of thyroid cartilage and middle point of clavicle bone or upper margin of stern were measured. Results The proportion of cases for recurrent laryngeal nerves intercrossed with inferior thyroid artery and for the crossing above the plane of inferior pole was respectively 88% and 96%. Therecurrent laryngeal never in front and rear of the inferi of thyroid artery and its branches were 22% and 50%,respectivdly.Most cases of RLN were behind Berry s suspensory ligament (95%). The distance between entering point of recurrent laryngeal nerve and inferior horn of thyroid cartilage was 8.2±2.5mm. Conclusion The results suggested that the correlation between RLN and its surrounding tissues is very complicated. The inferior horn of thyroid cartilage may be a useful marker for RLN.