胸骨上内镜下甲状腺切除术临床应用解剖学

目的:为胸骨上内镜下甲状腺手术术中甲状腺下动脉的处理和保护喉返神经提供解剖学基础。方法:采用40例(男30例,女10例)经动脉灌注福尔马林固定的成人尸体,解剖分离暴露甲状腺、甲状腺下动脉、气管前间隙、喉返神经等结构,观测甲状腺下动脉的行程、分支特点、与喉返神经分支的关系,以及甲状腺下动脉与甲状腺下极等解剖标志的相互位置关系。结果:(1)甲状腺下动脉基本上位于颈深筋膜中层的后方,只有在接近甲状腺侧叶的后缘处进入甲状腺假包膜后很短一段位于颈深筋膜内;(2)甲状腺下动脉进入甲状腺之前72.5%为3支型;(3)甲状腺下动脉分叉点分位于甲状腺下极后外上方;(4)喉返神经分支与甲状腺下动脉分支类型有5种。结论:掌握甲状腺下动脉的行程,提高手术操作技巧,术中有效控制出血和保护喉返神经,胸骨上内镜下甲状腺切除术是可行的。

Applied anatomy of endoscopic thyroidectomy through the upper part of sternum

Objective: To provide anatomic basis for dealing with inferior thyroid artery and protecting recurrent laryngeal nerve during endoscopic thyroidctomy through the upper part of sternum. Methods: 40 adult cadavers (30 men and 10 females) perfused with formalin were used. Thyroid, inferior thyroid artery, anterior space of trachea and recurrent laryngeal nerve were dissected carefully, while, the course and distribution of inferior thyroid artery and its relation with branches of recurrent laryngeal nerve was observed and measured. Results:(1)Inferior thyroid artery located behind the medial layer of cervical fascia mainly.(2)Before reaching thyroid, inferior thyroid artery divided into 2 or 3 branches, and 3 branches was more common (72.5%).(3) The bifurcation of inferior thyroid artery located at the posterolateral part of the lower extremity of thyroid.(4) The relations of branches of recurrent laryngeal nerve and inferior thyroid artery showed different 5 types. Conclusions: It is important to handle the course of inferior thyroid artery, improve operational skill, control hemorrhage and protect recurrent laryngeal nerve during endoscopic thyroidectomy through the upper part of sternum