经胸前壁径路内镜甲状腺手术的解剖学基础  

Anatomic basis of the anterior chest approach in endoscopic thyroidectomy

作　　者：李莉洁[1] 李国新[2] 吴涛[3] 郑向民[4] 丁自海[3] 侯致典[3] 江道振[4] 仇明[4] 

机构地区：[1]解放军第425医院普通外科,三亚572008 [2]南方医科大学南方医院普通外科,广州510515 [3]南方医科大学微创外科解剖研究所,广州510515 [4]第二军医大学长征医院普三科,上海200003

出　　处：《解剖学杂志》2013年第6期1091-1094,F0003,共5页Chinese Journal of Anatomy

摘　　要：目的：本研究通过对标本模拟经胸前壁径路的内镜甲状腺手术，明确一系列组织层面和结构间的相互位置关系。方法：对标本模拟施行了内镜甲状腺手术。结果：组织层面是胸前壁胸大肌筋膜与颈前深筋膜浅层为一连续的筋膜层面；内镜甲状腺分离三角是寻找甲状腺下动脉和甲状腺中静脉的～个重要层面。特殊组织结构位置关系为下甲状旁腺位于甲状腺下动脉的浅面；喉返神经位于下甲状旁腺的深面；上甲状旁腺与喉返神经入喉位置处于相同水平面。结论：指导外科医生安全地施行内镜甲状腺手术，避免损伤重要的结构。Objective： An initial anatomical study was carried out to identify the structural layers within surgical planes and the relationships among structural locations during the anterior chest approach of endoscopic thyroidectomy （ET）. Methods： Imitation of the anterior chest approach of a live ET procedure was performed on three cadavers. Results： The following structural layers were found： （1） The pectoralis major fascia of the breast and the superficial layer of the deep fascia of the neck were continuous; （2） A loose space was found between the thyroid gland and the parathyroid gland. Furthermore, the following positional relationships were discovered： （1） The inferior parathyroid gland was found beneath the inferior thyroid artery~ （2） the recurrent laryngeal nerve （RLN） was found beneath the inferior parathyroid gland; （3） a vessel was present above and parallel with the RLN; （4） the superior parathyroid gland was adjacent to the middle thyroid vein and on the same horizontal level with the posterior inferior cornu of the thyroid cartilage, where the RLN entered the larynx. Conclusion： These specific structural layers and positional relationships found in our study may guide surgeons in safe performance of ET as well as help to locate the surgieal planes and anatomic landmarks during a live ET procedure.

关 键 词：内镜甲状腺手术 解剖 解剖标志 

分 类 号：R472.3[医药卫生—护理学]