Objective To explore the clinical significance on protection of parathyroid and recurrent laryngeal nerve (RLN) by meticulous capsular dissection and exposure of RLN in thyroid lobectomy.
Methods Clinical data of 452 patients who underwent thyroid lobectomy by meticulous capsular dissection and exposure of RLN in our hospital from Jan. 2010 to Dec. 2012 were retrospectively analyzed.
Results All of the 452 cases underwent thyroid lebectomy successfully without death, and the operative time was 45-110min (average 60 min), the blood loss was 5-100mL (average 20mL). The pathological results showed that there were thyroid adenoma in 193 cases, nodular goiter in 175 cases, Hashimoto thyroiditis in 38 cases, thyroid cancer in 46 cases. After operation, 4 cases suffered RLN injury, 1 of the 4 cases recovered after removal of drainage tube, and other 3 cases recovered during 0.5 to 3.0 months. In addition, 2 cases suffered laryngeal nerve injury whose symptoms disappearred within 1 week, 5 cases suffered parathyroid founctional damage without permanent hypocalcemia whose symptom had kept 1-5 days after treatment. Three cases were reoperated because of bleeding, including branch of anterior venous bleeding in 1 case, thyroid side arterial tube bleeding in 1 case, and thyroid stump bleeding in 1 case. Twenty one cases suffered hypothyroidism in 1 month after operation, and no recurrence happened during the followed up period.
Conclusions Meticulous capsular dissection can effectively protect function of parathyroid and reduce the injury probability of RLN. Exposure of RLN is safe and feasible, which plays an important role in avoiding serious RLN injury.
Citation:
ZHOU Longxiang,YU Dong,XU Jun,SHEN Zhong,WU Zhongxin,.. Clinical Analysis of Thyroid Lobectomy by Meticulous Capsular Dissection and Exposure of Recurrent Laryngeal Nerve in 452 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(6): 638-642. doi:
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曾繁余, 张显岚, 张帆. 甲状腺腺叶切除术中喉返神经的保护[J]. 中华普通外科杂志, 2012, 27(4):286-288.
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邵选, 潘永海, 吴成亮, 等. 精细被膜解剖法原位保留甲状旁腺的临床应用[J]. 实用医学杂志, 2009, 25(13):2110-2111.
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Sheahan P, Murphy MS. Thyroid tubercle of zuckerkandl:impor-tance in thyroid surgery[J]. Laryngoscope, 2011, 121(11):2335-2337.
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滕卫平, 刘永锋, 高明, 等. 甲状腺结节和分化型甲状腺癌诊治指南[J]. 中华内分泌代谢杂志, 2012, 28(10):779-797.
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陈曦. 甲状腺手术中甲状旁腺功能的保护[J]. 中国实用外科杂志, 2010, 30(10):895-897.
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黄久佐, 汪劭婷, 李小毅. 甲状腺术后永久性甲状旁腺功能低减的防治[J]. 中国普外基础与临床杂志, 2012, 19(8):890-893.
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郭培义, 汤治平, 丁自海, 等. 颈部Berry韧带区的外科解剖[J]. 解剖学研究, 2011, 33(5):340-343.
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张海添, 陆云飞, 廖清华, 等. 甲状腺手术中显露喉返神经价值的Meta分析[J]. 中华普通外科杂志, 2005, 20(4):204-206.
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董泾青, 雷尚通. 甲状腺手术中显露喉返神经以避免喉返神经损伤的临床意义[J]. 中国普外基础与临床杂志, 2012, 19(3):297-299.
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符活, 张国庆. 甲状腺切除术中喉返神经损伤的防治[J]. 中国普外基础与临床杂志, 2009, 16(9):762.
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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.
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Cernea CR, Brandão LG, Hojaij FC, et al. How to minimize complications in thyroid surgery?[J]. Auris Nasus Larynx, 2010, 37(1):1-5.
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(1):34-38.
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小原孝男著, 董家鸿译. 内分泌外科要点与盲点[M]. 第2版.北京:人民卫生出版社, 2011:17-19.
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- 1. Zakaria HM, Al Awad NA, Al Kreedes AS, et al. Recurrentlaryngeal nerve injury in thyroid surgery[J]. Oman Med J, 2011,.
- 2. 程若川, 艾杨卿, 刁畅, 等. 甲状腺手术中甲状旁腺显露及功能保护的临床研究[J]. 中国普外基础与临床杂志, 2009, 16(5):351-355.
- 3. 曾繁余, 张显岚, 张帆. 甲状腺腺叶切除术中喉返神经的保护[J]. 中华普通外科杂志, 2012, 27(4):286-288.
- 4. 邵选, 潘永海, 吴成亮, 等. 精细被膜解剖法原位保留甲状旁腺的临床应用[J]. 实用医学杂志, 2009, 25(13):2110-2111.
- 5. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland:surgical anatomy and the importance of technique[J]. World J Surg, 2000, 24(8):891-897.
- 6. Serpell JW. New operative surgical concept of two fascial layers enveloping the recurrent laryngeal nerve[J]. Ann Surg Oncol, 2010, 17(6):1628-1636.
- 7. Yun JS, Lee YS, Jung JJ, et al. The zuckerkandl’s tubercle:a useful anatomical landmark for detecting both the recurrentlaryngeal nerve and the superior parathyroid during thyroid surgery[J]. Endocr J, 2008, 55(5):925-930.
- 8. Sheahan P, Murphy MS. Thyroid tubercle of zuckerkandl:impor-tance in thyroid surgery[J]. Laryngoscope, 2011, 121(11):2335-2337.
- 9. 滕卫平, 刘永锋, 高明, 等. 甲状腺结节和分化型甲状腺癌诊治指南[J]. 中华内分泌代谢杂志, 2012, 28(10):779-797.
- 10. Kiviniemi H, Vornanen T, Mäkelä J. Prevention of complications of thyroid and parathyroid surgery[J]. Duodecim, 2010, 126(3):269-275.
- 11. 陈曦. 甲状腺手术中甲状旁腺功能的保护[J]. 中国实用外科杂志, 2010, 30(10):895-897.
- 12. 黄久佐, 汪劭婷, 李小毅. 甲状腺术后永久性甲状旁腺功能低减的防治[J]. 中国普外基础与临床杂志, 2012, 19(8):890-893.
- 13. 黄韬. 甲状旁腺术中损伤的预防和处理[J]. 中国实用外科杂志, 2008, 28(3):179-180.
- 14. 杨予丹. 甲状腺手术中喉返神经显露与否与术后喉返神经损伤临床对比分析[J]. 浙江创伤外科, 2011, 16(2):229-230.
- 15. 赵俊, 孙善全. 甲状腺手术区喉返神经及其分支的应用解剖研究[J]. 中华外科杂志, 2001, 39(4):317-319.
- 16. 郭培义, 汤治平, 丁自海, 等. 颈部Berry韧带区的外科解剖[J]. 解剖学研究, 2011, 33(5):340-343.
- 17. 段云飞, 薛卫, 朱峰, 等. 应用精细被膜解剖法的全甲状腺切除术[J]. 中华内分泌外科杂志, 2012, 6(4):273-275.
- 18. Ahmed M, Abbas S, Boota M, et al. Should we routinely exposerecurrent laryngeal nerve(s) during thyroid surgery?[J]. J Coll Physicians Surg Pak, 2013, 23(3):186-189.
- 19. Miyauchi A, Masuoka H, Yabuta T, et al. The ima approach for the quick identification of the right recurrent laryngeal nerve in thyroid cancer surgery[J]. Surg Today, 2013, 43(2):225-228.
- 20. Flament JB, Delattre JF, P1uot M. Arterial blood supply to the parathyroid glands:implications for thyroid surgcry[J]. Anat Clin, 1982, 3(3):279-284.
- 21. 张海添, 陆云飞, 廖清华, 等. 甲状腺手术中显露喉返神经价值的Meta分析[J]. 中华普通外科杂志, 2005, 20(4):204-206.
- 22. 董泾青, 雷尚通. 甲状腺手术中显露喉返神经以避免喉返神经损伤的临床意义[J]. 中国普外基础与临床杂志, 2012, 19(3):297-299.
- 23. 符活, 张国庆. 甲状腺切除术中喉返神经损伤的防治[J]. 中国普外基础与临床杂志, 2009, 16(9):762.
- 24. 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.
- 25. Cernea CR, Brandão LG, Hojaij FC, et al. How to minimize complications in thyroid surgery?[J]. Auris Nasus Larynx, 2010, 37(1):1-5.
- 26. (1):34-38.
- 27. 小原孝男著, 董家鸿译. 内分泌外科要点与盲点[M]. 第2版.北京:人民卫生出版社, 2011:17-19.