改良Miccoli模式内镜手术的工作腔室：WSM-I型建腔器所成腔室的空间形态特征研究  

Working space establishment with Miccoli＇s approach： spatial characteristics of the cavity created by a working space marker

作　　者：王建彪[1] 高力[1] 宋春轶[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院头颈外科,浙江大学微创外科研究所,杭州310016

出　　处：《中华内分泌外科杂志》2011年第2期84-87,91,共5页Chinese Journal of Endocrine Surgery

基　　金：浙江省科技厅项目（2007C23017）

摘　　要：目的观测WSM—I型建腔器所成腔室的空间形态特征。方法2010年1月至8月在我院接受改良Miccoli模式内镜甲状腺手术40例。入路制备完成后，统一采用建腔器建腔。手术包括一侧腺叶及峡部切除13例，腺叶部分切除27例。于建腔操作中运用空间测量针测量建腔器所成腔室的长、宽、高度等参数。结果①腔室底面的基本长度为（4．35±0．39）cm；中心基本宽度为（4．66±0．53）cm；中心基本高度为（1．36±0．34）cm；中心最大高度为（1．66±0．32）cm；周边基本高度为（0．98±0．29）cm；周边最大高度为（1．33±0．14）cm。②腔室体积与肿块大小呈负相关。③在手提吊钩感觉明显阻力时，借助垂直向微调，还可将腔室中心高度提升0．3cm（22．1％）。④在周边基本高度基础上，借钩端三维定向调节，叮将该方位上的腔室周边高度增加0．35cm（35．7％）。结论建腔器所成腔室为一以钩端为脊顶的不规则形低矮类梯台状空间。此空间不仅非常稳定，且可灵活变形。后者可能是机械牵张法建腔的一个关键技术进步：总空间不变，通过三维调节，使有限空间得到最充分利用。Objective To comprehend spatial characteristics of the cavity created by a working space marker. Methods 40 patients were successively operated according to the surgical mode of minimally invasive video-assisted thyroideetomy from Jan. 2010 to Aug. 2010. Instead of hand-retraction, a mechanical arm--working space marker type I （ WSM-I , MIEO Medinstr Co. Ltd, China）, was applied to establish a working space. After the pathway making, a cavity above the gland was created and adjusted properly by the space maker, and then, endoscopic view was built and manipulation in the cavity was progressed throughout the later process. Geometric measurement of the cavity were performed at a ＂basic space position＂ just after the initial cavitation, and parameters such as length, width and height of the cavity were measured with a specifically scale-marked puncture needle （MC1820, Bard Max · Core Instrument） through mini-holes lay in the lifting hook （Ф4 mm, middle point and distant point）. Results 13 eases received a lobeetomy and isthmectomy. The other 27 cases reeeived a partial thyroideetomy. Dimensional parameters were caleulated as below. ①The basic length of cavity button was （4. 35 ±0. 39） era. The basic width of eavity button （distance at central point） was （4. 66 ±0. 53） era. The basic eentral height of cavity was （ 1.36 ±0. 34） cm. The maximal eentral height arehived by readjusting was （1.66±0. 32） em and a height increase of 0. 3 em can be achieved （22. 1% ）. ②The basic peripheral height was （0. 98 ±0. 29） cm. The maximal peripheral height arehived by readjusting direetionally was （ 1.33 ±0. 14） cm and a height increase of 0. 35 cm can be achieved （35.7%）. ③Statistic analysis yielded a negative correlation between the cavity volume and the size of the nodule. Conclusions The working space created by WSM-I appears to be an laigh and irregular trapezoid stock with oblique roof formed by lifting hook. Mthough vertical height, especially the peripheral heig

关 键 词：甲状腺手术 微创 内镜辅助 工作腔室 

分 类 号：R653[医药卫生—外科学]