与颈部手术相关的喉返神经的应用解剖

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1、·460·CHINESEJOURNALOFCLINICALANATOMYVOL.21NO.52003·应用解剖·与颈部手术相关的喉返神经的应用解剖冉建华,孙善全,赵俊,彭雪华(重庆医科大学解剖学教研室,重庆400016)【摘要】目的:为颈部手术中喉返神经的定位和保护提供形态学和局部解剖学基础。方法:解剖50具(100侧)成人颈部尸体标本,对喉返神经及其分支进行定位观测。结果:(1)喉返神经的分支有喉支和喉外支,前者在入喉前多分为前支、后支。87%的喉返神经分支呈树枝状,13%的喉返神经分支之间或分

2、支与颈交感干之间相互吻合呈袢状。(2)有2%的双喉返神经和1%的非返喉下神经。(3)94%的喉返神经的喉支多在距甲状腺下角尖端(16.9±7.6)mm处分为前、后支,喉外支多在其下10.4～70.4mm范围内发出。(4)喉返神经与甲状腺下动脉的关系分为5种类型。(5)喉返神经与颈部食管及颈动脉鞘的位置关系复杂。结论:在颈部相关手术中应注意喉返神经的变异,通过显露和辨认喉返神经防止其损伤。【关键词】喉返神经;甲状软骨下角;甲状腺下动脉【中图分类号】R322.81;R323.1【文献标识码】A【文章编

3、号】1001-165X(2003)05-0460-04AnappliedanatomicalstudyontherecurrentlaryngealnerveanditsbranchesintheregionofnecksurgeryRANJian2hua,SUNShan2quan,ZHAOJun,etal.DepartmentofAnatomy,ChongqingUniversityofMedicalSciences,Chongqing400016,China【Abstract】Objectiv

4、e:Toprovidesomespecialinformationaboutthemorphologyandtopographyofthere2currentlaryngealnerve(RLN)anditsbranchesforthelocationandprotectioninnecksurgery.Methods:Fiftyadultcadavericspecimens(100sides)fixedwithformalinweredissected,analysedandmeasured.R

5、esults:(1)Alloftherecurrentlaryngealnervebifurcatedintolaryngealbranchandextralaryngealbranch,theformerusuallydividedintotheanteriorbranchandposteriorbranchbeforeenteringthelarynx.87.0%oftheRLNsgaveoffseveralbrancheslikeatree;ananastomoticloopconnecti

6、ngonebranchoftheRLNtoanotheroratwigoriginat2edfromthecervicalsympatheticchainin13outofthe100cases.(2)RLNsexistinginbothleftsideandrightsideappearedin2sides;anonrecurrentinferiorlaryngealnerveappearedin1case.(3)94.0%ofthelaryngealbranchesoriginatedfrom

7、theRLNdividedintotheanteriorandposteriorbranches,thepointswereabout16.9±7.6mmawayfromtheinferiorhornofthyroidcartilarge;Theextralaryngealbrancheswereoriginatedfromtheregionwhereundertheinferiorhornofthyroidcartilageabout10.4～70.4mm.(4)Therelationsbetw

8、eenRLNandtheinferiorthyroidarteryweredividedinto5types.(5)TherelationsoftheRLNwiththeneckesophagusandthecarotidsheathwerecomplicated.Conclusion:TopreventanyinadvertentinjurytotheRLNthesurgeonmustbeawareofthedifferentpatternoftheRLN,identifythe