颈伸位下头颈三维重建在甲状腺手术中的应用

  目的  探究在颈伸位下三维重建头颈结构在甲状腺手术中的应用价值。  方法  选择20例已经由病理结果证实的甲状腺疾病患者在颈伸位下的平扫CT图像，应用三维重建软件3DVWorks，对甲状腺、甲状腺结节、甲状软骨、下颌骨、锁骨、皮肤等组织进行三维重建，测量多个空间角度及径线以评估疾病及治疗方案。  结果  通过在头颈三维重建模型中对下段气管所在的不同平面与甲状腺手术相关解剖结构的角度与距离测量，综合评估后在甲状腺结节 < 3 cm的11例患者中有3例患者不适合行经口腔镜术式，可行其他腔镜等术式；3例患者不适合行经口、经胸乳腔镜术式及经腋窝等腔镜手术，仅适合开放手术；1例患者因结节分期较高，不推荐行腔镜手术；另外4例患者各类手术均可施行。通过构建胸廓入口及以此平面准确分割巨大甲状腺体积，对6例含有结节 > 3 cm的巨大甲状腺进行预评估后发现均未达经颈胸联合切除甲状腺的指标要求，6例患者行传统单纯经颈切口即可完整切除甲状腺。对有残留甲状腺的3例患者，预评估显示3例残余甲状腺均可准确定位并能指导手术切除。  结论  通过在颈伸位下三维重建头颈结构并建立评估指标，对腔镜手术方式选择、巨大甲状腺肿诊治、残余甲状腺术中定位有独特优势，有助于形成良好的手术策略，更有益于医患交流。 

Application of three-dimensional reconstruction of head and neck with neck extension in thyroid surgery

  Objective  To evaluate the clinical application of three-dimensional reconstruction of head and neck with neck extension in thyroid surgery.  Methods  The unenhanced CT images which were scan with neck extension of 20 patients proved to be thyroid disease by pathology were collected. The thyroid gland, thyroid nodules, thyroid cartilage, mandible, clavicle, and skin were reconstructed with the software of 3DVWorks. Measuring different angles and diameters for disease evaluation and treatment base on the reconstruction model.  Results  In the 3D reconstruction model of head and neck, intersectoral angles and distances between different tracheal planes and anatomic structures of endoscopic thyroidectomy were measured. Based on these 3D data, 3 of 11 patients with thyroid nodule < 3 cm were not suitable for endoscopic thyroidectomy via a transoral approach. Meantime, 3 patient was not suitable for the thoracic and breast approach or axillo-breast approach and 1 patient was only suitable for open surgery. The other 4 of 11 patients were suitable for all surgical approaches. 6 patients with thyroid nodule > 3 cm were not diagnosed with a substernal goiter by the model, which could be accessible via a transcervical approach but not a transsternal operative approach. The model showed residual thyroid after surgery in 3 cases could be located accurately and directed the operation.  Conclusion  Three-dimensional reconstruction of head and neck with neck extension has unique advantages in choice of operative approach, diagnosis, and treatment of substernal goiter and intraoperative localization of residual thyroid tissue, which help to make a better surgical decision and benefit physician-patient communication.