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杨敬, 严淑萍, 龚艳萍等. X线胸片检查和颈部血管超声对预测喉不返神经的价值[J]. koko体育app 学报(医学版), 2014, 45(6): 1036-1039.
引用本文: 杨敬, 严淑萍, 龚艳萍等. X射线胸片检验和下颚血官超声心动图对预測喉不返周围神经的交换价值[J]. 上海二本大学学报(医学界版), 2014, 45(6): 1036-1039.

X线胸片检查和颈部血管超声对预测喉不返神经的价值

  • 摘要: 目的 通过对甲状腺手术患者术前、术中及术后资料的分析,评估X线胸片和颈部血管超声预测喉不返神经(non-recurrent laryngeal nerve,NRLN)的价值。 方法 对2006年1月至2013年12月的2 251例行甲状腺手术的患者术前常规检查X线胸片,通过仔细阅读胸片预测NRLN,术后对证实存在NRLN的患者行颈部血管超声评估。 结果 2 251例患者中49例(2.18%)X线胸片怀疑存在右锁骨下动脉畸形(aberrant right subclavian artery, ARSA),其中23例(46.94%)术中证实存在NRLN,均无NRLN损伤。2 202例X线胸片未怀疑存在ARSA者,5例(0.23%)术中证实存在NRLN,其中1例(20.00%)损伤。术中证实存在NRLN的28例患者,术后颈部血管超声检查示存在ARSA,X线胸片怀疑存在ARSA而手术证实无NRLN的26例患者,术后颈部血管超声显示为正常右锁骨下动脉(right subclavian artery,RSA)。预测存在NRLN的23例患者术中NRLN神经显露时间比未怀疑存在NRLN的5例患者短(t=-18.867 2,P=0.000 0)。 结论 甲状腺手术患者术前应仔细阅读X线胸片,联合颈部血管超声预测ARSA。ARSA能准确预测NRLN,降低NRLN的损伤率和缩短手术时间。  
    Abstract: Objective To determine the value of chest X-ray and cervical vascular ultrasound in predicting the presence of non-recurrent laryngeal nerves (NRLN) in patients with thyroid disorders. Methods Preoperative, intraoperative and postoperative documents of 2 251 patients with various thyroid disorders between January 2006 and December 2013 were reviewed. All of the patients underwent preoperative chest X-ray examinations. The patients who had confirmed NRLN during surgery were given a cervical vascular ultrasound examination postoperatively. Results A total of 49 patients (2.18%, A group) were identified having NRLN by preoperative chest X-ray as they showed aberrant right subclavian artery (ARSA). Of those suspected cases of NRLN, 23 (46.94%) were confirmed during subsequent surgeries and no NRLN injury was inflicted. In the 2 202 unsuspected cases (B group), 5 (0.23%) were discovered having NRLN during surgeries, and one (20.00%) NRLN injury occurred. ARSA were found in postoperative cervical vascular ultrasound examination in all of the 28 cases of NRLN confirmed during surgeries. The postoperative cervical vascular ultrasound suggested a normal right subclavian artery (RSA) for the 26 chest X-ray revealed but surgically dismissed cases of NRLN. The 23 X-ray predicted NRLN were revealed more quickly in surgeries than those that had been failed to show in X-ray (t=-18.867 2, P=0.000 0). Conclusion Chest X-ray of patients scheduled for thyroid surgery should be reviewed carefully and cervical vascular ultrasound should be allied for predicting ARSA before surgery. Detection of ARSA can accurately predict the existence of NRLN, preventing NRLN injury and shorten the duration of subsequent operations.  
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