经口内镜甲状腺切除术及颈部淋巴结清扫术的人体标本手术实验研究  

Total trans-oral endoscopic thyroidectomy and cervical lymphadenectomy： a human cadavers surgery study

作　　者：苏远航[1] 汤治平[2] 丁自海[4] 汪华侨[5] 吴涛[4] 梁建深[1] 岑宏[1] 赵象文[3] 丁纪伟[3] 华伟[3] 汤聪[1] 

机构地区：[1]中山大学附属第五医院微创中心,广东省珠海市519000 [2]南方医科大学附属中山博爱医院 [3]南方医科大学附属小榄医院 [4]南方医科大学微创外科解剖学研究所 [5]中山大学中山医学院人体解剖学教研室

出　　处：《中华外科杂志》2013年第6期552-555,共4页Chinese Journal of Surgery

摘　　要：目的研究在人体标本上利用常规腹腔镜手术器械行经口内镜甲状腺切除术及颈部淋巴结择区清扫术的解剖路径、手术技术可行性及安全性，寻找一种既能满足美容和心理需求，又能减少手术创伤且便于临床应用的腔镜甲状腺手术入路。方法选取6具冻存新鲜尸体，分组进行不同径路的经口腔trocar安置实验：经口腔前庭，经舌下区，口腔前庭联合舌下区。根据实验选择最佳径路，在另外6具尸体上行经口入路腔镜甲状腺切除术及颈部淋巴结清扫实验。结果trocar安置实验中，经口腔前庭组出现大范围黏膜、皮下组织撕裂，气密性遭破坏；经舌下区组因空间过小，无法安装其余操作用trocar；而经口腔前庭联合舌下区组未见明显腺体、血管、神经损伤。采用口腔前庭联合舌下入路方案，成功进行甲状腺腺叶全切除术，并对颈Ⅲ、Ⅳ、Ⅵ、Ⅶ区淋巴结行清扫术，未造成明显副损伤。结论经口腔前庭联合舌下区方案是经口内镜甲状腺切除术较合理的布局方案，经此入路行内镜甲状腺切除术及颈淋巴结择区清扫是可行的。Objective To find an approach for trans-oral endoscopic thyroidectomy （TOET） and cervical lymphadeneetomy using conventional endoscopic surgical instruments on frozen fresh cadavers. Methods Six frozen fresh cadavers were used in three groups of trans-oral trocar installation experiments： oral vestibule installation, sublingual region installation, and combined bi-vestibular and sublingual installation. TOET （with pretrachealis method to thyroid fixation removal ） and cervical lymphadeneetomy were performed experiments on another 6 frozen fresh cadavers using the best access approach found in the aforementioned experiments. Results In oral vestibule trocar installations, the trocars caused large lacerated wound and damaged air tightness. In sublingual installations, only one trocar could be installed in the sublingual area because the space in sublingual area was limited. In combined bi-vestibular and sublingual installations, no gland, vessel or nerve was damaged. Combined bi-vestibular and sublingual access were selected as the surgical approach on the basic of analysis the merits of each approach. TOET and cervical lymphadeneetomy in area Ⅲ, Ⅳ, Ⅵ, Ⅶ were performed without making any accessory damage through combined bi-vestibular and sublingual access approach. Conclusions TOET is feasible. Combined bi-vestibular and sublingual approach is available for TOET. Part of the cervical lymph nodes could be resected. Pretrachealis approach to thyroid fixation removal can still be used.

关 键 词：甲状腺切除术 内窥镜检查 口腔 颈淋巴结清扫术 

分 类 号：R65[医药卫生—外科学]