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喉返神经喉外分支的显微解剖及临床意义
Microanatomical and clinical significance of the recurrent laryngeal nerve in the thyroid region
目的 探讨甲状腺手术区域喉返神经（RLN）的解剖特点和方法。方法 运用大体解剖的方法，对48例成人标本甲状腺手术区域的RLN及其周围毗邻结构进行了观测。结果 48例96侧成人标本中，29%RLN主干穿过环咽肌肌束至致密结缔组织膜下缘，71% RLN主干走行在环咽肌深面。69% RLN在距离甲状软骨下角尖端(15.2±5.5)mm处分为前、后两支，前支多于环状软骨侧方下缘距离甲状软骨下角尖端(5.9±1.8)mm处穿过结缔组织膜，后支入喉点距甲状软骨下角尖端(4.8±2.1)mm；31%RLN未见分支。结缔组织膜下缘RLN与甲状腺下动脉(ITA)分支的关系为：66%(63/96)RLN位于ITA前方，27%(32/96)位于ITA后方。结论 大多数RLN具有喉外分支，在以甲状软骨下角作为标志寻找RLN时，要同时找寻RLN及喉外分支的入喉点。ITA与RLN的关系复杂多变，ITA不作为RLN定位的首选。
Objective To investigate the anatomic characteristics of the recurrent laryngeal nerve in the thyroid region. Methods The recurrent laryngeal nerve and its surrounding structures of 48 adult cadavers were examined with gross anatomical technique. Results The relationship between the recurrent laryngeal nerve and the lateral cricopharyngeal triangle in 48 adult cadavers (96 sides) was detected. The main trunk of the recurrent laryngeal nerve coursed superiorly and entered into the lateral cricopharyngeal triangle either through (29%，28/96 sides) or deep to (71%，68/96 sides) the cricopharyngeal muscle. The entering point of recurrent larynageal nerve into the larynx was（5.9±1.8）mm inferior to the inferior cornu of the thyroid cartilage. At the level of（15.2±5.5）mm inferior to the inferior cornu of the thyroid cartilage，69% (66/96 sides) of the recurrent laryngeal nerve gave off a small branch to the larynx and its entering point into the larynx was (4.8±2.1) mm inferior to the inferior cornu of the thyroid cartilage. The spatial relationship between the recurrent larynageal nerve inferior to connective tissue membrane and the inferior thyroid artery branch was below the triangle， and the nerve ran either in front of (66%，63/96 sides) or posterior to (33%，32/96 sides) the inferior thyroid artery. Conclusion Correct identification and safe dissection of the recurrent laryngeal nerve are essential in surgery. Most of the recurrent larynageal nerve have external laryngeal branch. It is necessary to confirm the entering point of recurrent larynageal nerve into the larynx while trying to find recurrent larynageal nerve based on the location of the inferior cornu of the thyroid cartilage. The relationship between the inferior thyroid artery and the RLN is complicated, thus the inferior thyroid artery may not be considered as the first choice to localize the recurrent laryngeal nerve.
Inferior thyroid artery / Recurrent laryngeal nerve / Microanatomy / Adult
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