喉上神经外支在环甲间隙的应用解剖学研究
收稿日期: 2013-11-25
网络出版日期: 2014-12-04
基金资助
河北省科技厅科研计划项目(13277746D)
Applied anatomy of the lateral branch of the superior laryngeal nerve in the avascular space
Received date: 2013-11-25
Online published: 2014-12-04
目的 为甲状腺手术中保护喉上神经外支提供解剖学基础。 方法 成人尸体32具(64侧)，解剖观察喉上神经外支在环甲间隙的解剖学特点，观察该神经与间隙内其他解剖结构的关系。 结果 3侧喉上神经存在袢状结构；发现所有标本中均存在环甲肌支，71.8%（46侧）存在咽支；按Friedman分型方法进行分型：Ⅰ型占28.1%（18侧）、Ⅱ型占54.7%（35侧）、Ⅲ型占17.2%（11侧）。喉上神经外支入咽下缩肌点位置均位于胸骨甲状肌深面，斜线下方。喉上神经外支入咽下缩肌点至斜线的垂直距离为（3.60±0.30） mm，距胸骨甲状肌内侧缘的垂直距离（8.27±1.72）mm，距环状软骨中点的距离是（27.09±1.46）mm。 结论 甲状腺手术中，从环甲间隙入路多数情况下可以显露保护喉上神经外支环甲肌支；大于17.2%的情况下不能显露，但也不会损伤。
关键词： 甲状腺手术; 喉上神经外支; 环甲间隙; Friedman分型
王占龙 , 宋晓飞 , 吴干勋 , 赵岩 , 石健 , 刘胜辉 , 李双成 , 赵瑞力 . 喉上神经外支在环甲间隙的应用解剖学研究[J]. 中国临床解剖学杂志, 2014 , 32(6) : 633 -636 . DOI: 10.13418/j.issn.1001-165x.201
Objective To provide the anatomical basis to protect the lateral branch of the superior laryngeal nerve during the thyroid surgery. Methods 32 Chinese cadavers (64 sides) were dissected to explore anatomic features of the lateral branch of the superior laryngeal nerve (EBSLN ) in the avascular space, and observe the close relationship between the LBSLN and other anatomical structures in this space. Result The superior laryngeal nerve loop was observed on 3 sides. On all sides, the EBSLN provided the cricothyroidal branch. The pharyngeal branch was found on 46 (71.8%) sides. The Friedman classification was used to define variations in EBSLN. Type 1, type 2 and type 3 accounted for 28.1%（18/64）, 54.7%（35/64）and 17.2%（11/64）, respectively. The point EBSLN penetrated the inferior constrictor muscle is located under the sternothyroid muscle. The vertical distance between the point where the nerve penetrated the inferior constrictor and slash was (3.60±0.30) mm. The vertical distance between the point where the nerve penetrated the inferior constrictor and the medial margin of sternothyroid muscle was (8.27±1.72) mm. The distance between the point where the nerve penetrated the inferior constrictor and the midpoint of the lower edge of the cricoid cartilage was (27.09±1.46) mm. Conclusion Most of EBSLNs could be exposed and protected by the surgical approach of the potential avascular space. In more than 17.2% cases, EBSLN may not be found, but it will not be damaged.
[1] Cernea CR, Ferraz AR, Nishio S, et al. Surgical anatomy of the external branch of the superior laryngeal nerve
[J]. Head Neck，1992, 14(5): 380-383.
[2] 曾志成，杨科球，王淼，等.喉上神经的应用解剖
[J]. 中国临床解剖学杂志,1996,14（1）：38-40.
[3] 石健，王占龙，吴干勋，等.甲状腺手术中两种喉上神经外支寻找方法的比较
[J].临床耳鼻咽喉头颈外科杂志, 2012，26(24）：1140-1141.
[4]Sun SQ, Chang RW. The superior laryngeal nerve loop and its surgical implications
[J]. Surg Radiol Anat,1991, 13(3): 175-180.
[5]孙善全,董剑平.喉上神经袢的应用解剖
[J].中国临床解剖学杂志,1995,13(4)：258-262.
[6]Friedman M, LoSalvio P, Ibrahim H, et al. Superior laryngeal nerve identification and preservation in thyroidectomy
[J]. Arch Otolaryngol Head Neck Surg, 2002, 128(3) : 296-303.
[7]Hisham A，Bliss R，Reeve T，et al．Recognition of the avascular space medial to the upper pole of the thyroid and its surgical implications
[J]．Asian J Surg, 2000, 23(1):86-89.
[8] Bliss RD，Gauger PG，Delbridge LW．Surgeon’s approach to the thyroid gland：surgical anatomy and the importance of tec-hnique
[J]．World J Surg, 2000, 24(8): 891-897.
[9] Aina EN, Hisham AN. External laryngeal nerve in thyroid surgery:Recognition and surgical implications
[J]. ANZ J Surg, 2001, 71(4): 212-214.
[10]Furlan JC. Sympathetic fiber origin of the superior Laryngeal nerve and its branches: an anatomic study
[J]. Clin Anat, 2002, 15(4): 271-275.
[11]黄海霞，王兴路，唐文静，等.喉上神经袢的新亚型及临床应用
[J].解剖学杂志，2012,35(5)：635-638.
[12]盛国生. 喉上神经损伤的预防
[J]. 中国实用外科杂志, 1993, 13(10):603-605.
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