内镜下经气管入路甲状腺切除术的应用解剖及临床意义  

Applied anatomy and clinical significance of transtracheal endoscopic thyroidectomy

作　　者：姜恒[1] 刘鸿[2] 谢拥军[3] 徐义全[4] 

机构地区：[1]成都医学院临床输血教研室,成都610083 [2]成都医学院基础医学院临床医学系,成都610083 [3]成都医学院人体解剖学教研室,成都610083 [4]四川省肿瘤医院头颈外科,成都610043

出　　处：《第三军医大学学报》2012年第13期1318-1321,共4页Journal of Third Military Medical University

摘　　要：目的通过研究经气管的解剖通路及毗邻的解剖结构,探讨经此路径行甲状腺切除术的安全可行性。方法在5具固定标本上参照气管入路对口腔、咽部及颈前部逐层解剖,并确定其解剖路径及层次。15具(未经防腐固定的)标本上运用动脉预灌注血管铸型,计算机X线断层扫描,薄层冰冻铣切等方法,对甲状腺及毗邻术区的解剖结构作系统研究。结果经气管的操作通道为自固有口腔,经咽峡、会厌下缘、喉咽、喉中间腔区域,移行至气管颈部区,在气管软骨环前壁作矢状切口至甲状腺术区。声带在外展位通过CT扫描,其形似梯形,矢状位高(长)男性为(20.12±3.25)mm,女性为(15.68±2.56)mm,前部宽为(2.10±0.50)mm,后部宽为(9.00±0.80)mm,中部上下厚为(5.00±0.85)mm,声门裂外展位横径为(5.50±1.45)mm是喉腔最狭窄之处。结论完全内镜行甲状腺切除术经气管入路作为在人体自然通道中实施的有创性操作,具有解剖学的安全性及可行性。Objective To investigate the feasibility and safety of totally thyroidectomy through transtracheal endoscopy by studying the anatomical approach and adjacent structures. Methods A total of 5 embalmed adult cadavers were dissected layer by layer in the cervical region, pharyngeal region and mandible region according to transtracheal assisted sublingual approach that was verified from the anatomical approach and planes. Another 15 fresh adult cadavers were dissected by blood vascular casting technique, imaging scanning technique and thin layer cryotomy. The anatomical structures of the thyroid gland surgical region were analyzed and studied qualitatively and quantitatively. Results The transtracheal operational access was placed from the eavitas otis propria, isthmus faueium, subepiglottic region, laryngeal pharynx, and intermediate laryngeal cavity, and then passed from the top down in order to reach pars eervicalis tracheae where a sagittal incision was observed in the anterior wall of cartilagines tracheales to reach ascertained surgical region. CT scanning showed abduction vocal cords were in trapezoidal shape with a sagittal height （length） of 20.12 ± 3.25 mm for male and 15.68 ± 2.56 for female, a frontal width of 2.10 ± 0.50 mm, a back width of 9.00 - 0.80 mm, and a middle thickness of 5.00± 0.85 mm. The transverse diameter of abduction true glottis was 5.50 ± 1.45 mm, which was the narrowest part in eavum laryngis. Conclusion As natural orifice transluminal endoscopic surgery, totally endoscopic thyroidectomy through transtracheal approach is feasible and safe anatomically.

关 键 词：甲状腺切除术 内镜 解剖学 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学] R581.05[医药卫生—基础医学]