摘要
目的探讨Zuckerkandl结节的解剖及其在甲状腺手术中作为喉返神经解剖标志的临床意义。方法147例患者（良性106例，恶性41例）甲状腺手术中解剖出喉返神经。测量Zuckerkandl结节大小并分级；辨认Zuckerkandl结节与喉返神经的关系并分型；解剖甲状腺下极并辨认喉返神经与甲状腺下动脉的关系。结果共对233（左107、右126）侧甲状腺进行解剖。左侧成功解剖93．5％，右侧成功解剖96．0％。Zuckerkandl结节分级如下：0级，左16．O％右13．2％；I级，左32．0％右27．3％；II级，左46．0％右44．6％；Ⅲ级，左6．0％右14．9％。两侧Zuckerkandl结节分级之间无明显差异。Zuckerkandl结节与喉返神经的关系分型如下：A型，左92．9％，右93．3％；B型，左0右0；C型，左7．1％，右6．7％。左右两侧无明显区别。Zuckerkandl结节分级与喉返神经走行之间存在一定相关性：Zuckerkandl结节分级越高，喉返神经从其内后方走行越多；Zuckerkandl结节分级越低，喉返神经自其外侧通过者越多。右侧喉返神经危险型的发生率（19．O％）高于左侧（8．3％）；Zuckerkandl结节与喉返神经的关系对评估甲状腺下极喉返神经通过甲状腺下动脉的方式无明显意义。结论Zuckerkandl结节是甲状腺手术中定位与解剖喉返神经的重要标志，Zuckerkandl结节分级对喉返神经的解剖及术中损伤的预防有指导意义。
Objective To study the anatomic characteristics of Zuckerkandl＇s tubercle （ZT） and its clinical relevance as an anatomic landmark of the recurrent laryngeal nerve （RLN） in thyroid surgery. Methods This study involved 147 （106 with benign thyroid diseases and 41 with malignancies ） patients who underwent thyroidectomy. ZT was measured and classified based on the Pelizzo classification. The relationship between ZT and the RLN and the relationship between the RLN and the inferior thyroid artery were recognized and classified. Results 233 （107 left and 126 right） thyroid gland lobes were dissected and ZT was identified in most patients （ left in 93.5% and fight in 96.0% ）. The distribution of ZT according to grade was as follows： Grade 0, left 16. 0% and right 13.2% ; Grade I , left 32.0% and fight 27.3% ; Grade ]] , left 46. 0% and fight 44. 6% ; Grade Ill, left 6. 0% and right 14. 9%. There was no significant difference on classification between the left-sided and right-sided ZTs. In terms of the relationship between the ZT and the RLN, it was classified as follows： Type A, left 92. 9% and fight 93.3% ; Type B： left 0 and fight 0; Type C： left 7.1% and fight 6.7%. Similarly, there was no significant difference between the left sided and the fight sided. The ZT grade was correlated with the course of the RLN： the higher the ZT grade was （ that is, the greater the size of the ZT）, the more often was the course of RLN behind the back of the ZT ; the lower the ZT grade （ that is, the smaller the size of the ZT）, the more often was the course of RLN running by the lateral of the ZT. Considering the incidence of being dangerous type of RLN, the right sided （ 19. 0% ） was higher than the left sided （ 8.3% ）. The relationship between the ZT and the RLN does not relate to RLN course across the inferior thyroid artery. Conclusions As an important anatomic landmark, the ZT is essential for locating and dissecting the RLN during thyroid surgery, and its classification is a guide to RLN dissection and preservation.
出处
《中华普通外科杂志》
CSCD
北大核心
2013年第2期100-103,共4页
Chinese Journal of General Surgery
