内镜下甲状腺手术的应用解剖

目的探讨内镜下甲状腺的应用解剖。方法对6例新鲜成人男性尸体标本,按照胸骨切迹小切口入路和胸前入路的手术步骤进行内镜下观察和记录。结果经颈部的自然间隙进行内镜下手术解剖,能清楚的显露与手术程序相关的结构和毗邻关系;更容易识别血管、喉返神经和甲状旁腺;提供了内镜下各部位的解剖和毗邻的图解;进行侧后面的解离及显露或侧缘与颈动脉鞘之间解离时,应用30°或70°镜更利于视野,采用经典的解剖标志来识别辨认喉返神经和甲状旁腺;内镜的放大作用给颈部的解剖结构提供了出色的可视性,更容易鉴别喉返神经和血管及甲状旁腺,利于防止喉返神经的损伤和保存甲状旁腺的血供;肩胛舌骨肌上腹是腋前入路一个重要的解剖标志。结论利用颈部的自然间隙进行内镜下手术解剖,能清楚的显露与手术程序相关的结构和毗邻关系。

Applied anatomic study of endoscopic thyroid surgery

Objective To explore applied anatomy for endoscopic thyroid suegery. Methods Six fresh adult cadavers were studied. The dissection was performed by two approaches: small incision approach on stern notch and anterior chest approach. The whole procedures were observed and recorded under endoscope. Results Dissecting under endoscope through natural cervical space could expose the relevant structures and surroundings clearly. And it was easier to identify blood vessel , recurrent laryngeal nerve and parathyroid gland. Also, Illustrations of anatomy structure and surroundings under the endoscope. Dissecting under endoscope through natural cervical space could expose the relevant structures and surroundings clearly. Using 30° or 70° endoscope a better view for dissecting and exposing lateral aspect or dissecting between lateral aspect and carotid artery sheath, recurrent laryngeal nerve and parathyroid gland could be identified by classical anatomic signs. Since the magnification of endoscope had provided a good view for neck structures , it was easier to identify recurrent laryngeal nerve and parathyroid gland and it was safe and effective to deal with the branches of inferior thyroid arteria. It could prevent injury of recurrent laryngeal nerve and preserve the blood supply of parathyroid gland. Superior belly of omohyoid was an important anatomic landmark when anterior chest approach was used. Conclusion Using natural space in neck, it is illustrations of anatomical structure and surroundings under the endoscope.