甲状腺周围筋膜及筋膜间隙的应用解剖学观察

目的　从临床应用解剖角度重新认识甲状腺周围筋膜及筋膜间隙的解剖特点,为甲状腺癌中央区清扫术的手术范围、入路层面等提供可以借鉴的解剖依据。  方法　5具10侧标本,对甲状腺周围筋膜和筋膜间隙进行观察;10例甲状腺癌患者进行手术解剖验证观察。  结果　气管前筋膜分为前后两层,两层之间是脂肪淋巴组织及甲状腺下静脉等;气管前间隙是气管前筋膜后层与气管之间的无血管的间隙。气管旁脂肪组织与气管前脂肪组织相延续,甲状腺血管、淋巴系统走行其中。气管旁、气管前脂肪淋巴组织前后均有一层筋膜覆盖,前后筋膜在外侧与血管鞘相融合,并开口于甲状腺血管根部,内侧与甲状腺相连,其结构与功能均类似肠系膜。气管旁脂肪组织在前方与甲状腺之间存在一间隙,后方与椎前筋膜之间存在一间隙。  结论　甲状腺有系膜且呈“U”分布于气管前及气管旁。甲状腺系膜切除能达到彻底清扫中央区淋巴组织的目的。甲状腺系膜与脏器之间的筋膜间隙是进行手术操作的外科平面。     

Perioperative evaluation of glycaemic status in neck dissection: a retrospective analysis at a single hospital centre

Diabetes mellitus is generally considered a risk factor for impaired wound healing. This study aimed to evaluate the glycaemic status of patients undergoing neck dissection and describe its impact on postoperative outcomes, especially wound healing. A retrospective analysis was performed of the preoperative, intraoperative, and postoperative glycaemic data obtained from the medical charts of 60 adult patients who had undergone 64 neck dissections. Nine of the 64 procedures were performed in diabetic patients (14.1%). The average glucose values were: preoperative 5.99 ± 1.25 mmol/l, intraoperative 8.90 ± 2.62 mmol/l, and postoperative 10.01 ± 2.49 mmol/l. All registered preoperative hyperglycaemia cases (eight cases) were diabetic. Postoperative insulin therapy was done in 14 procedures (21.9%). Wound healing complications were found in five patients (7.8%); there was no wound infection. There was no association of wound healing complications with preoperative diabetic status (P = 1.000), preoperative glucose control (P = 1.000), preoperative (P = 0.469), intraoperative (P = 0.248), and postoperative (P = 0.158) glucose values, or with postoperative glucose control (P = 0.577). These data do not support the association of stress-induced hyperglycaemia or diabetes mellitus with postoperative wound healing problems in neck dissection.     

超声刀在颈淋巴清扫术中的临床应用

目的 :探讨超声刀技术在口腔颌面头颈部鳞癌施行颈淋巴清扫术中的临床应用价值和手术技巧。方法 :2007-02—2012-12期间,随机交叉选取口腔黏膜鳞状细胞癌432例患者,分为超声刀组(216例)和电刀组(216例)。比较2组的手术时间、失血量、术后24h引流量、术后住院天数以及术后并发症的发生等项目。结果:与电刀组相比较,超声刀组在手术时间、术中失血量、24h引流量、住院天数等方面具有明显优势,经统计学分析,P<0.05为差异有统计学意义。结论:应用超声刀技术施行颈淋巴清扫术,具有传统高频电刀所不具有的组织分离和切割、凝固止血三种功能合一体的优点,实用手术技巧与超声刀技术联合应用,可使颈淋巴清扫完全达到根治性要求。是一种值得临床推广,且有应用前景的颈淋巴清扫治疗策略。     

纳米碳混悬液作图法在乳腺癌新辅助化疗后腋窝淋巴结清扫中检出数目及腋窝微小淋巴结检出数目中的临床优势

目的对比纳米碳混悬液作图法与无染料法在乳腺癌新辅助化疗后腋窝淋巴结清扫中淋巴结检出数目及腋窝微小淋巴结检出数目中的效果。方法选择四川省肿瘤医院乳腺外科2018年1月1日至2018年7月1日经新辅助治疗后拟接受腋窝淋巴结清扫手术的乳腺癌患者66例,行前瞻性研究。采用随机数字表法随机分为纳米碳作图法组(33例)和对照组(33例),分别使用术前24 h皮下注射纳米碳后再行腋窝淋巴结清扫与不使用染料直接行腋窝淋巴结清扫两种方法,统计两组患者腋窝淋巴结检出数目及腋窝微小淋巴结检出数目情况。结果纳米碳作图法组腋窝淋巴结检出数目及微小淋巴结检出数目均高于对照组,差异均有统计学意义[腋窝淋巴结数目:(19.3±6.2)枚与(14.9±6.7)枚,P=0.007;腋窝微小淋巴结数目:2.0(0.5,3.0)枚与0(0,1.0)枚,Z=-4.328,P<0.001]。结论纳米碳混悬液作图法可以增加乳腺癌新辅助化疗后腋窝淋巴结清扫中淋巴结检出数目,同时对一些不易发现的腋窝微小淋巴结的检出也具有优势。