右侧非返性喉返神经伴右锁骨下动脉变异2例
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1.南京医科大学附属肿瘤医院&2.江苏省肿瘤医院&3.江苏省肿瘤防治研究所;4.amp;5.南京医科大学附属肿瘤医院头颈科;6.南京医科大学附属肿瘤医院肿瘤内科;7.南京医科大学附属肿瘤医院放疗科

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江苏省卫生健康委科研项目


Two cases of right non-recurrent laryngeal nerve with right subclavian artery variation:a case report
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Affiliation:

1.The Affiliated Cancer Hospital of Nanjing Medical University &2.Jiangsu Cancer Hospital &3.Jiangsu Institute of Cancer Research;4.amp

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Scientific research project of Jiangsu Provincial Health Commission

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    摘要:

    正常喉返神经(recurrent laryngeal nerve, RLN)由迷走神经分出,在左侧绕主动脉弓,在右侧绕右锁骨下动脉,沿气管食管沟上行入喉。非返性喉返神经(non-recurrent laryngeal nerve, NRLN)又称喉不返神经,是RLN的一种罕见解剖学变异,其从甲状腺外侧迷走神经分出后不返行而直接入喉。右侧NRLN的形成与胚胎动脉发育异常有关,发生率为0.3%~0.8%,右侧RLN因右锁骨下动脉解剖变异而无动脉牵制时才出现右侧NRLN。左侧NRLN发生率为0.004%,仅见于右位主动脉弓或右位心人群。在行甲状腺手术过程中,若未能识别NRLN可能造成神经损伤,单侧NRLN损伤可能导致声音嘶哑,双侧损伤可能导致呼吸困难。因NRLN极低的发生率与损伤的不良后果,现结合甲状腺癌术中所遇两例右侧NRLN伴右锁骨下动脉变异的诊疗经验结合文献进行报道,希望有助于指导临床医生识别此类罕见变异,两例均证实为Toniato IIA型,即平行于甲状腺下动脉并横行入喉。

    Abstract:

    The normal recurrent laryngeal nerve (RLN) is separated from the vagus nerve and orbits the aortic arch on the left and the right subclavian artery on the right, traveling up the tracheoesophageal sulcus into the larynx. The non-recurrent laryngeal nerve (NRLN), also known as the laryngeal non-return nerve, is a rare anatomical variant of the RLN that separates from the lateral vagus nerve of the thyroid gland and enters the larynx without returning. The formation of right NRLN is associated with abnormal embryonic artery development, with an incidence of 0.3% to 0.8%, and the right side NRLN appears only when there is no arterial containment due to anatomical variation of the right subclavian artery. The incidence of left NRLN is 0.004%, which is seen only in people with right aortic arch or right heart. Failure to recognize NRLNs during thyroid surgery may cause nerve damage, unilateral NRLN injuries may result in hoarseness, and bilateral injuries may cause dyspnea. Due to the extremely low incidence of NRLN and the adverse consequences of injury, the diagnosis and treatment experience of two cases of right NRLN with right subclavian artery mutation encountered during thyroid cancer surgery is now reported in conjunction with the literature, hoping to help guide clinicians to identify such rare variants, and both cases have been confirmed to be Toniato IIA type, that is, parallel to the inferior thyroid artery and traversed into the larynx.

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  • 收稿日期:2022-04-15
  • 最后修改日期:2023-08-09
  • 录用日期:2023-10-20
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