气管前筋膜的再认识及其在甲状腺癌手术中的意义  

Re-recognization of pretracheal fascia and its clinical significance in thyroid operation

作　　者：雷尚通[1] 丁自海[2] 葛军娜[1] 赵东辉[1] 

机构地区：[1]南方医科大学南方医院普通外科,广州510515 [2]南方医科大学微创解剖研究所,广州510515

出　　处：《中国临床解剖学杂志》2015年第2期126-128,133,共4页Chinese Journal of Clinical Anatomy

基　　金：广东省自然科学基金(S2013010016565);南方医科大学科研启动计划项目(PY2013N034)

摘　　要：目的从应用解剖学的角度重新认识气管前筋膜及其周围间隙,为甲状腺癌手术提供解剖学依据。方法对福尔马林固定的尸体标本进行解剖以及术中甲状腺癌患者的气管前筋膜进行观察,观察气管前筋膜及气管前间隙的特点。结果气管前筋膜分为前后两层,两层筋膜之间是甲状腺峡部、脂肪、气管前淋巴结、甲状腺最下动脉、胸腺,甲状腺下静脉等。前层筋膜与舌骨下肌筋膜之间存在一间隙,为舌骨下肌后间隙;后层筋膜与气管之间存在一个无血管的间隙,为气管前间隙,该间隙向下通向纵膈,向上经甲状腺峡部后方通向喉前,向两侧延伸至气管食管沟。结论气管前筋膜分为前后两层,分离显露甲状腺及气管前脂肪淋巴组织时应该保持气管前筋膜前层的完整性;气管前间隙是处理峡部和气管前淋巴结的外科层面。Objective To revisit the pretracheal fascia and the fascial space from the perspective of applied anatomy, and provide the anatomical basis for thyroid surgery. Methods To observe the anatomical features of pretracheal fascia and fascial space through dissection of pretracheal fascia on cadavers and patients with thyroid cancer. Results Pretracheal fascia is divided into two layers, between which structures such as isthmus of thyroid,fat tissues, pretracheal lymph nodes, lymphatic vessels, inferior thyroid vein could be found, assuming a sandwich-like appearance. There is a vessel-free space between the posterior layer of pretracheal fascia and the trachea, called the preteacheal space,which extended downward to the mediastinum, upward to the back of the isthmus and pyramidal lobe,laterally to tracheoesophageal groove.Conclusions Pretracheal fascia is divided into two layers. the integrity of the anterior layer of pretracheal fascia should be maintained when the thyroid and pretracheal fat lymphoid tissues were exposed. Pretracheal space is the surgical plane of dissection for removal of the isthmus,pyramidal lobe of and the pretracheal lymph nodes.

关 键 词：气管前筋膜 筋膜间隙 甲状腺 手术 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]