目的 探討甲狀腺手術方式和喉返神經損傷（RLN）的關系。 方法 回顧性分析2009年1月至2012年6月期間于筆者所在醫院科室接受開放性甲狀腺手術的985例患者的臨床資料，探討甲狀腺手術方式和RLN損傷的關系。 結果 本組患者術后發生RLN損傷26例（2.6%），未發生RLN損傷959例（97.4%）。logistic回歸分析結果顯示，年齡、性別、超聲刀應用、麻醉方式及腫塊良惡性與RLN損傷均無關（P＞0.05），而手術范圍（OR=3.726，P=0.007）和顯露RLN（OR=0.302，P=0.006）則是RLN損傷的影響因素，行擴大性手術及未顯露RLN者的RLN損傷率較高。 結論 在開放性甲狀腺手術中，手術范圍以及顯露RLN是RLN損傷的獨立影響因素，術中顯露并注意保護RLN，對避免RLN損傷具有重要意義。
Objective To explore the relationship between external branch of superior laryngeal nerve (EBSLN) injury and the approachs of surgery in open thyroidectomy, and to summarize the preventive methods. Methods The clinical data of 985 patients who had consecutively underwent open thyroidectomy from January 2009 to June 2012 were retrospectively analyzed, to explore the relationship between EBSLN injury and the approachs of surgery in open thyroidectomy. Results The overall incidence of EBSLN injury was 2.6% (26/985), and 959 patients (97.4%) didn’t suffered from EBSLN injury. Results of logistic regression showed that the extent of surgery (OR=4.536, P=0.004) and identification of the EBSLN (OR=0.126, P=0.044) were influence factors of EBSLN injury after open thyroidectomy, but age (OR=1.108, P=0.823), gender (OR=0.604, P=0.260), benign or malignant tumor (OR=1.871, P=0.186), anesthesia methods (OR=0.659, P=0.372), and the application of ultrasonic scalpel (OR=0.473, P=0.248) were not associated with EBSLN injury. Conclusion In open thyroidectomy, the extent of surgery and identification of EBSLN are the independent factors of EBSLN injury, which are important to avoid EBSLN injury.