摘要
目的 探讨不同喉上神经外侧支的分型对临床的指导,进而寻找针对性更强、更便捷地保护喉上神经外侧支的技术。方法 回顾性分析2018年10月—2019年2月于河北医科大学第四医院行甲状腺手术的80例患者(110侧)(均为同一外科手术团队所做)喉上神经外侧支的临床资料,分别按照Friedman、Cernea及本研究探索的赵分型进行分类,并应用单因素及多因素Logistic回归分析探讨赵分型中喉上神经外侧支损伤的危险因素。结果 根据Friedman分型进行分型:Ⅰ型28.2%,Ⅱ型58.2%,Ⅲ型13.6%。根据Cernea分型进行分型:Ⅰ型11.8%,Ⅱa型51.8%,Ⅱb型36.4%。赵分型中,肿物位于上极者及肥胖患者,是造成上极血管断扎次数较多的危险因素;肿物位于上极者及甲状腺体积过大,是上极血管断扎时造成喉上神经外侧支易损伤的危险因素。喉上神经外侧支位于环甲动脉下方者居多。结论 在各种喉上神经外侧支分型中赵分型方法更针对临床手术操作技巧。由环甲动脉和甲状腺上极交角处开始分离环甲间隙是寻找喉上神经外侧支的可靠方法。血管进入甲状腺上极腺体点到喉上神经外侧支的最短距离决定了喉上神经外侧支的易损程度。甲状腺上极肿物、甲状腺体积过大及肥胖患者,是喉上神经外侧支易受损的独立危险因素,处理时需谨慎。
Objective To investigate the clinical guidance value of different classification systems for the external branch of the superior laryngeal nerve(EBSLN),thereby identifying more targeted and efficient techniques for its preservation.Methods A retrospective analysis was performed on the clinical data of the EBSLN from 80 patients(110 sides)who underwent thyroid surgery from October 2018 to February 2019(all procedures were performed by the same surgical team).The EBSLN was classified according to the Friedman,Cernea,and the Zhao classification system proposed in this study.Univariate and multivariate logistic regression analyses were used to investigate the risk factors for EBSLN injury under the Zhao classification.Results Based on Friedman classification,there was TypeⅠ(28.2%),TypeⅡ(58.2%),and TypeⅢ(13.6%).As for Cernea classification,there was TypeⅠ(11.8%),TypeⅡa(51.8%),and TypeⅡb(36.4%)In the Zhao classification,tumors located at the superior pole and obese patients were risk factors for an increased number of ligations of the superior pole vessels.Tumors at the superior pole and excessive thyroid volume were risk factors for EBSLN injury during the ligation of the superior pole vessels.The EBSLN was most frequently located inferior to the cricothyroid artery.Conclusion Among the various EBSLN classification systems,the Zhao classification is more specifically tailored to clinical surgical techniques.Initiating the dissection of the cricothyroid space from the angle between the cricothyroid artery and the thyroid superior pole is a reliable method for locating the EBSLN.The shortest distance from the point where the vessels enter the superior pole of the thyroid gland to the EBSLN determines the nerve's susceptibility to injury.Superior pole thyroid tumors,large thyroid volume,and obesity are independent risk factors for EBSLN injury,necessitating careful management during surgery.
作者
徐玉茹
景丰
兰利利
时萍
刘猛
赵瑞力
XU Yu-ru;JING Feng;LAN Li-li;SHI Ping;LIU Meng;ZHAO Rui-li(Department of Otolaryngology Head and Neck Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Otolaryngology Head and Neck Surgery,the First Central Hospital of Baoding City,Hebei Province,Baoding 071000,China)
出处
《河北医科大学学报》
2025年第12期1392-1398,共7页
Journal of Hebei Medical University
基金
河北省财政厅政府资助优秀医学人才课题项目(ZF2025197)。
关键词
甲状腺切除术
喉上神经外侧支
神经保护
thyroidectomy
the external branch of the superior laryngeal nerve
neuroprotection
