喉返神经及其分支的应用解剖学研究

发布时间：2019-02-11 20:50

【摘要】： 喉返神经与甲状腺、食管、气管、颈部血管关系密切且变异较多,尤其是其分支形态、与甲状腺下动脉的关系以及喉支入喉的情况更为复杂。在颈部手术中常因喉返神经的损伤而造成术后声音嘶哑、呼吸困难甚至窒息等严重并发症。多年来外科专家运用解剖学数据,在颈部手术中采用了多种技术防止喉返神经损伤,以使手术更为安全有效。但至今为止有关喉返神经损伤的病例仍时有报道,资料记载,喉返神经损伤的发生率为0.3%～13.3%。由于临床上涉及颈部的手术量很大,因此术中发生喉返神经损伤的病例并不是一个小数目。如何进一步降低手术中的喉返神经损伤率一直是头颈外科临床治疗的一个难点。究其原因主要是由于喉返神经及其分支在解剖上的特殊性和复杂性。目前有关其分支走行和变异情况的资料还相对欠缺。本文利用30具(60侧)防腐尸体头颈部标本解剖出喉返神经及其分支、甲状腺下动脉、甲状软骨下角、甲状腺下极、观测喉返神经及其分支形态、走行、入喉点及其与甲状腺下动脉、甲状软骨下角、甲状腺下极的关系。重点测量喉返神经横径、喉支的前后支入喉处与甲状软骨下角尖端的距离以及喉返神经分支发出部位和甲状腺下极平面的垂直距离。并对喉返神经损伤的因素、喉返神经的变异、术中辨认喉返神经的标志以及如何对喉返神经进行解剖和保护等问题做了较深入的阐述。以期为临床手术提供更详实的解剖资料。
[Abstract]:The recurrent laryngeal nerve is closely related to thyroid, esophagus, trachea and cervical blood vessels, especially its branch morphology, and the relationship with the inferior thyroid artery and the laryngeal branch is more complicated. Postoperative hoarseness, dyspnea and even asphyxia are often caused by the injury of recurrent laryngeal nerve in neck surgery. Over the years, surgical experts have used anatomical data to prevent recurrent laryngeal nerve injury in neck surgery, so as to make the operation more safe and effective. Up to now, however, the incidence of recurrent laryngeal nerve injury is still reported. The incidence of recurrent laryngeal nerve injury is 0.313.3%. There is not a small number of patients with recurrent laryngeal nerve injury due to the large amount of surgery involved in the neck. How to further reduce the rate of recurrent laryngeal nerve injury has been a difficult point in head and neck surgery. The main reason is the anatomical particularity and complexity of the recurrent laryngeal nerve and its branches. At present, there is a relative lack of information on the movement and variation of its branches. The recurrent laryngeal nerve and its branches, inferior thyroid artery, hypothyroidism angle, inferior thyroid pole were dissected from 30 cadavers (60 sides). The morphology of recurrent laryngeal nerve and its branches were observed. The point of entry into the larynx and its relationship with the inferior thyroid artery, the inferior angle of thyroid cartilage and the lower extremity of the thyroid gland. The transverse diameter of the recurrent laryngeal nerve, the distance between the anterior and posterior branches of the laryngeal branch and the tip of the inferior angle of thyroid cartilage, and the vertical distance between the origin of the branch of the recurrent laryngeal nerve and the lower polar plane of the thyroid gland were measured. The factors of recurrent laryngeal nerve injury, the variation of recurrent laryngeal nerve, the mark of identifying recurrent laryngeal nerve during operation, and how to anatomize and protect the recurrent laryngeal nerve were also discussed. In order to provide more detailed anatomical data for clinical operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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