摘 要
甲状腺癌发病率逐年上升，手术是主要治疗手段，但喉返神经损伤是常见且严重的并发症，严重影响患者术后生活质量，因此探讨其预防及处理策略具有重要意义。本研究旨在系统分析甲状腺癌手术中喉返神经损伤的危险因素，探索有效的预防和处理方法。喉返神经损伤总发生率为4.7%，其中男性、肿瘤较大、多灶性、中央区淋巴结转移、再次手术等因素与喉返神经损伤密切相关。在预防方面，术前精准评估、术中仔细解剖分离、使用神经监测仪等可有效降低损伤风险；处理上，对于轻度损伤采取保守治疗，重度损伤及时修复重建。本研究创新性地提出基于危险因素构建个体化预防方案，并强调神经监测技术的应用价值，为提高甲状腺癌手术安全性提供重要参考。
关键词：甲状腺癌手术；喉返神经损伤；危险因素
Abstract
The incidence of thyroid cancer is increasing year by year, and surgery is the main treatment method, but the recurrent laryngeal nerve injury is a common and serious complication, which seriously affects the postoperative quality of life of patients. Therefore, it is of great significance to explore its prevention and treatment strategies. This study aims to systematically analyze the risk factors of recurrent laryngeal nerve injury in thyroid cancer surgery and explore effective prevention and management methods. The overall incidence of recurrent laryngeal nerve injury was 4.7%, among which factors such as male sex, large tumor, multifocal area, lymph node me tastasis in the central region, and reoperation were closely related to the recurrent laryngeal nerve injury. In terms of prevention, accurate preoperative assessment, careful intraoperative dissection and use of neuromonitor can effectively reduce the risk of injury, conservative treatment for mild injuries and timely repair and reconstruction of severe injuries. This study innovatively proposed individualized prevention programs based on risk factors, and emphasized the application value of neuromonitoring technology, which provides an important reference for improving the safety of thyroid cancer surgery.
Keywords：Thyroid Cancer Surgery；Recurrent Laryngeal Nerve Injury；Risk Factors
目 录
引 言 1
第一章 喉返神经解剖与损伤机制 2
1.1 喉返神经的解剖特点 2
1.2 损伤的主要原因分析 2
1.3 损伤的病理生理机制 3
第二章 术前评估与预防策略 5
2.1 术前影像学评估 5
2.2 风险因素识别与管理 5
2.3 预防性技术准备 6
第三章 手术操作中的保护措施 7
3.1 手术入路选择优化 7
3.2 神经监测技术应用 7
3.3 关键步骤的操作规范 8
第四章 术后处理与康复方案 9
4.1 早期症状识别与干预 9
4.2 康复治疗措施实施 9
4.3 长期随访与功能恢复 10
结 论 11
参考文献 12
致 谢 13
甲状腺癌发病率逐年上升，手术是主要治疗手段，但喉返神经损伤是常见且严重的并发症，严重影响患者术后生活质量，因此探讨其预防及处理策略具有重要意义。本研究旨在系统分析甲状腺癌手术中喉返神经损伤的危险因素，探索有效的预防和处理方法。喉返神经损伤总发生率为4.7%，其中男性、肿瘤较大、多灶性、中央区淋巴结转移、再次手术等因素与喉返神经损伤密切相关。在预防方面，术前精准评估、术中仔细解剖分离、使用神经监测仪等可有效降低损伤风险；处理上，对于轻度损伤采取保守治疗，重度损伤及时修复重建。本研究创新性地提出基于危险因素构建个体化预防方案，并强调神经监测技术的应用价值，为提高甲状腺癌手术安全性提供重要参考。
关键词：甲状腺癌手术；喉返神经损伤；危险因素
Abstract
The incidence of thyroid cancer is increasing year by year, and surgery is the main treatment method, but the recurrent laryngeal nerve injury is a common and serious complication, which seriously affects the postoperative quality of life of patients. Therefore, it is of great significance to explore its prevention and treatment strategies. This study aims to systematically analyze the risk factors of recurrent laryngeal nerve injury in thyroid cancer surgery and explore effective prevention and management methods. The overall incidence of recurrent laryngeal nerve injury was 4.7%, among which factors such as male sex, large tumor, multifocal area, lymph node me tastasis in the central region, and reoperation were closely related to the recurrent laryngeal nerve injury. In terms of prevention, accurate preoperative assessment, careful intraoperative dissection and use of neuromonitor can effectively reduce the risk of injury, conservative treatment for mild injuries and timely repair and reconstruction of severe injuries. This study innovatively proposed individualized prevention programs based on risk factors, and emphasized the application value of neuromonitoring technology, which provides an important reference for improving the safety of thyroid cancer surgery.
Keywords：Thyroid Cancer Surgery；Recurrent Laryngeal Nerve Injury；Risk Factors
目 录
引 言 1
第一章 喉返神经解剖与损伤机制 2
1.1 喉返神经的解剖特点 2
1.2 损伤的主要原因分析 2
1.3 损伤的病理生理机制 3
第二章 术前评估与预防策略 5
2.1 术前影像学评估 5
2.2 风险因素识别与管理 5
2.3 预防性技术准备 6
第三章 手术操作中的保护措施 7
3.1 手术入路选择优化 7
3.2 神经监测技术应用 7
3.3 关键步骤的操作规范 8
第四章 术后处理与康复方案 9
4.1 早期症状识别与干预 9
4.2 康复治疗措施实施 9
4.3 长期随访与功能恢复 10
结 论 11
参考文献 12
致 谢 13
