甲状腺手术内镜新入路的应用解剖学基础  

Applied Anatomy of A New Approach of Endoscopic Technique in Thyroid Gland Surgery

作　　者：刘鸿[1] 谢拥军[2] 徐义全[3] 李超[4] 刘兴国[2] 

机构地区：[1]成都医学院基础医学院临床医学系,成都610083 [2]成都医学院人体解剖学教研室,成都610083 [3]广西医科大学研究生院肿瘤学系,南宁530021 [4]四川省肿瘤医院肿瘤研究所头颈外科,成都610041

出　　处：《中国医学科学院学报》2012年第5期515-522,共8页Acta Academiae Medicinae Sinicae

摘　　要：目的通过对气道联合舌下的解剖通路、层次及毗邻结构的实验研究,为经此入路完全内镜下行甲状腺切除术的安全可行性提供解剖学依据。方法在5例(成都医学院人体解剖实验室受捐)结构完整经防腐固定的头颈部成年标本上参照气道联合舌下入路行口腔底、咽部及颈前部解剖,确定经此入路的解剖路径及层次。15例结构完整未经防腐固定的新鲜头颈部成年标本,运用丙烯腈-丁二烯-苯乙烯共聚物丁酮溶液行左右颈总动脉预灌注,分别作血管铸型、计算机断层扫描技术及薄层冰冻铣切等方法,对甲状腺及毗邻术区的解剖结构作定性和定量研究,并运用Autodesk3ds Max 2010(32位)对喉部动脉进行三维重建。在5例结构完整未经防腐固定的新鲜头颈部成年标本上模拟经气道联合舌下解剖路径完全内镜下甲状腺切除术。结果经舌下的内镜通道为自舌下正中区,依次穿行颏舌骨肌、下颌舌骨缝、颏下三角区至颈阔肌深面,经封套筋膜、舌骨体前缘、舌骨下肌群至甲状腺术区。经气道的操作通道为自固有口腔,依次经咽峡、会厌下缘、喉咽、喉中间腔,移行至气管颈部,在气管软骨环前壁作矢状切口至甲状腺术区。结论完全内镜气道联合舌下入路行甲状腺切除术在解剖上有其安全操作层次和范围可循,在临床上对甲状腺外科领域具有参考价值。Objective To explore the feasibility and safety of transtracheal assisted sublingual ap- proach to totally endoscopic thyroidectomy by studying the anatomical approach and adjacent structures. Meth- ods A total of 5 embalmed adult cadavers from Chengdu Medical College were dissected layer by layer in the cervical region, pharyngeal region, and mandible region, according to transtracheal assisted sublingual ap- proach that was verified from the anatomical approach and planes. A total of 15 embalmed adult cadavers were dissected by arterial vascular casting technique, imaging scanning technique, and thin layer cryotomy. Then the vessel and anatomical structures of thyroid surgical region were analyzed qualitatively and quantitatively. Three-dimensional visualization of larynx artery was reconstructed by Autodesk 3ds Max 2010 （32）. Transtra- cheal assisted sublingual approach for totally endoscopic thyroidectomy was simulated on 5 embalmed adult ca- davers. Results The sublingual observed access was located in the middle of sublingual region. The geniohy- old muscle, mylohyoid seam, and submental triangle der the plastyma muscles. passed Superficial cervical fascia, were divided in turn in the middle to reach the plane un- anterior body of hyoid bone, and infrahyoid muscles were in sequence to reach thyroid gland surgical region. The transtracheal operational access was placed from the cavitas oris propria, isthmus faucium, subepiglottic region, laryngeal pharynx, and intermediate laryngeal cavit, and then passed from the top down in order to reach pars cerviealis tracheae where a sagittal incision was made in the anterior wall of cartilagines tracheales to reach a ascertained surgical region. Conclusion Transtra- cheal assisted sublingual approach to totally endoscopic thyroidectomy is anatomically feasible and safe and can be useful in thyroid gland surgery.

关 键 词：甲状腺切除术 内镜 解剖学 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]