The protection of exposure recurrent laryngeal nerve in thyroid surgery

Abstract

Objective To study the anatomy,exposure and operation method in prevention of recurrent laryngeal nerve injury in thyroid surgery.Methods The clinical data of 520 patients with thyroid disease in treatment of operation were retrospectively analyzed,and exposure of recurrent laryngeal nerve in 268 cases,non exposure of recurrent laryngeal nerve in 252 cases; resection of the majority of thyroid in 232 cases,resection of ipsilateral thyroid lobe+ isthmus+on the side of most resection operation in 220 cases; resection of ipsilateral thyroid thyroidectomy+contralateral subtotal+ipsilateral lymph node dissection operation in 68 cases.Results Exposure of recurrent laryngeal nerve in 268 cases.The recurrent laryngeal nerve in the external laryngeal branch was single 214 cases,accounted for 79.9％ (214/268); two 42 cases,accounted for 15.7％ (42/268),more than 12 cases,accounted for 4.5％ (12/268).The laryngeal recurrent nerve during thyroid artery through the rear 143 cases,accounted for 53.4％(143/268) ; during thyroid artery through the front 92 cases,accounted for 34.3％ (92/268); walk line between thyroid artery branches 33 cases,accounted for 12.3％(33/268).The thyroid permanent damage rate of exposure of recurrent laryngeal nerve surgery was 1.1％(3/268),lower than that in non exposure of recurrent laryngeal nerve surgery 6.0％ (15/252) (P ＜ 0.05).The thyroid permanent damage rate between resection of the majority of thyroid and resection of ipsilateral thyroid lobe + isthmus + on the side of most resection operation had no significant difference (P ＞0.05),compared with the former two,resection of ipsilateral thyroid thyroidectomy + contralateral subtotal + ipsilateral lymph node dissection operation increased significantly (P ＜0.05).Exposure of.recurrent laryrngeal nerve in benign 173 cases,6 cases of thyroid transient damage,permanent damage in 1 case; 95 cases of malignant thyroid,6 cases of thyroid transient damage,permanent damage in 2 cases,the thyroid permanent damage rate in both had no significant difference (P ＞ 0.05).Conclusion Exposure of recurrent laryngeal nerve operation can significandy reduce the incidence of recurrent laryngeal nerve injury,for the partial thyroidectomy,can chose non exposure of recurrent laryngeal nerve operation method. Key words: Thyroidectomy; Recurrent laryngeal nerve; Thyroid diseases