Rekürren laringeal sinirin anatomik seyri ve tiroid cerrahisindeki komşu yapılar ile ı̇lişkisi
The anatomy and associatons with the neighbouring structures of the recurrent laryngeal nerve
- Tez No: 461625
- Danışmanlar: DOÇ. DR. BORA BAŞARAN
- Tez Türü: Tıpta Uzmanlık
- Konular: Kulak Burun ve Boğaz, Otorhinolaryngology (Ear-Nose-Throat)
- Anahtar Kelimeler: recurrent laryngeal nerve, thyroid, thyroidectomy
- Yıl: 2017
- Dil: Türkçe
- Üniversite: İstanbul Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Kulak Burun Boğaz ve Baş-Boyun Cerrahisi Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 48
Özet
Amaç: Türkiye toplumunda rekürren laringeal sinirin komşu yapılar ile anatomik ilişkisini araştırmak ve bu yapılar ile rekürren sinirin ilişkisini tanımlamak Gereç ve Yöntem: Ocak 2013 ile Aralık 2016 tarihleri arasında kliniğimizde tiroidektomi operasyonu yapılan 91 hasta araştırmaya dahil edildi. Kocher'in kolye insizyonu ile operasyona başlandı, tüm vakalarda rekürren laringeal sinir bulundu ve çevredeki anatomik yapılar ile ilişkisi not edildi. Veriler SPSS 21.0 kullanılarak ki-kare test ile analiz edildi p
Özet (Çeviri)
Aim: Researching and defining the anatomic relation of the recurrent laryngeal nerve with the adjoining structures in Turkish population. Materials and Methods: 91 patients who undergone thyroidectomy in our clinic between January 2013 and December 2016 were included. Operations were started with Kocher's incision. Recurrent laryngeal nerve was found, and the anatomic associations with the neighboring structures were noted. The data were analyzed by using SPSS 21.0 with chi square test, and the results were found statistically meaningful with a p value < 0.05. Results: Men / Women ratio of this population of 91 patients is 27/64. The youngest of the patients is 14 years old and the oldest is 86 years old with the average of 50.2. A total of 151 thyroid lobectomies were performed, of which 75 was right and 76 was left sided. In one patient non-recurrent laryngeal nerve was observed, and when this patient was excluded in 40 (%26.7) of the remaining 150 thyroid lobectomy material the nerve was found anterior to the tracheo-osephageal groove, in 93 (%62) patients in the groove, and in 17 (%11.3) patients posterior to groove. When the position between the nerve and the Berry ligament observed, in 114 (%76) lobectomies the nerve was lateral to the ligament, and in 36 (%24) patients the nerve was found penetrating into the ligament. In 29 (%19.3) lobectomies the nerve was found passing anterior to the inferior thyroid artery, in 17 (%11.3) between the divisions of the artery, in 104 (%69.4) patients posterior to the artery. In 8 (%5.3) lobectomies the nerve was found penetrating inferior constrictor pharyngeal muscle, in 142 (%94.7) patients was found entering the larynx just below the muscle fibers. In 9 patients (%6) the recurrent laryngeal nerve divided before entering larynx. There was no significant difference in relationship between the nerve and the associated anatomic structures for each side found. (Trache-osephageal groove (p=.892), Berry ligament (p=.635), Inferior thyroid artery (p=.312), Inferior pharyngeal constrictor muscle (p=.444), extralaryngeal division(p=.762)) Conclusion: A great variation can be seen in recurrent laryngeal nerve anatomy. In order to avoid recurrent laryngeal nerve damage the nerve must be dissected, and followed very carefully at the level of the inferior thyroid artery and Berry ligament where the variations can be seen at most.
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