甲状腺癌右侧喉不返神经与颈交感神经交通1例报道

Right non-recurrent laryngeal nerve and cervical sympathetic nerve communication of thyroid carcinoma: a case report

摘要:

目的 总结1例少见的甲状腺癌术中发现右侧喉不返神经和颈交感神经交通并汇合后入喉患者的病例资料，以引起临床医生的重视。方法 分析1例30岁女性体检发现甲状腺结节，术前细针穿刺细胞学结果考虑甲状腺乳头状癌，在全麻下行手术治疗，术中探查发现该患者右侧喉不返神经和颈交感神经交通并汇合后入喉，术中给予精细解剖，喉返神经完整，手术顺利完成。结果 术后患者发声正常，没有声音嘶哑、饮水呛咳等并发症。术后4 d顺利出院，术后6周患者门诊复查纤维喉镜提示双侧声带活动正常。结论 在甲状腺手术中，需要加深对喉返神经解剖及其变异的认识，按层次仔细分离和解剖，以保护喉返神经的完整性。

Abstract:

Objective The recurrent laryngeal nerve has many branches and anatomical variations. Here, a rare case of the right laryngeal nerve communicating with the cervical sympathetic nerve is reported, which will attract the attention of clinicians. Methods The physical examination of a 30-year-old woman revealed a thyroid nodule. Before the operation, the fine needle biopsy cytology was proved to be thyroid papillary carcinoma, and the patient had an operation under general anesthesia. Intraoperative exploration found that that the patient's right non-recurrent laryngeal nerve communicated with the cervical sympathetic nerve, then becoming one up into the larynx, which is a rare anatomical variation of the laryngeal recurrent nerve. With careful dissection, the laryngeal recurrent nerve was kept intact. Results The patient's voice was normal, no hoarseness, drinking water cough and other complications after surgery. The patient was discharged from hospital successfully 4 days after the operation. Fibrolaryngoscopy showed that bilateral vocal cord activity was normal 6 weeks after surgery. Conclusions In thyroid surgery, it is necessary to enhance the understanding of the anatomy and variation of the recurrent laryngeal nerve. Careful separation and precise dissection in different layers are mandatory so as to protect the neural integrity.