改良Miccoli术中喉返神经的显露及损伤预防

目的：探讨甲状腺改良Miccoli术中解剖显露喉返神经的方法及预防喉返神经损伤的临床意义。方法：回顾性分析218例行甲状腺改良Miccoli术患者的资料，均在内镜直视下寻找喉返神经并进一步显露直至人喉处，行甲状腺次全切或腺叶全切除。结果：218例患者手术均获成功，无中转开放手术。术中均成功显露颈段喉返神经并保护之。术中、术后病理证实结节性甲状腺肿185例，甲状腺腺瘤8例，甲状腺乳头状微小癌25例。2例甲状腺乳头状微小癌及1例有鼻咽癌放疗史的患者，术后出现暂时性声嘶，3个月内声带活动恢复正常。结论：甲状腺改良Miccoli术中解剖显露喉返神经是该手术顺利进行的关键，是预防喉返神经损伤的有效方法。

Identification techniques of the recurrent laryngeal nerve in modified Miccoli style endoscopic thyroidectomy

Objective：To study the role of anatomizing the recurrent laryngeal nerve（RLN） in preventing the injury in thyroid surgery. Method：A retrospective study of 218 patients performed identification of RLN in modi- fied Miccoli style endoscopic thyroidectomy treated. Under endoscope, all patients underwent sub-total thyroidec- tomy or lobe thyroidectomy, and the RLN of all patients were anatomized to the site of proximal of the larynx. Re- suit： All cases underwent sub-total thyroidectomy except for 25 cases who were diagnosed as papillary thyroid canc- er during surgery, and they were referred to lobe thyroidectomy. Totally 316 RLNs were dissected. Neither tran- sient nor permanent RLN injury occurred in 215 cases. Two cases diagnosed as papillary thyroid cancer and 1 case with radiated therapy for nasopharyngeal cancer suffered hoareness postoperatively, and recoverd 3 months after surgeries. Conclusion： Correct identification of RLN which can prevent injuring RLN which is essential in modified Miccoli style endoscopic thyroidectomy.