经口腔前庭腔镜甲状腺手术通道的解剖研究及临床应用效果  

The anatomical study and its clinical application result of the surgery channels of endoscopic thyroidectomy via oral vestibular approach

作　　者：冯志起[1] 王存川[2] 王小忠[1] 李进义[2] 杨华[2] 杨景哥[2] 

机构地区：[1]汕头市中心医院,中山大学附属汕头医院,广东汕头515031 [2]暨南大学附属第一医院

出　　处：《腹腔镜外科杂志》2016年第4期251-254,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经口腔前庭腔镜甲状腺手术通道的解剖要点及临床应用效果。方法:在9具人体标本上围绕手术部位进行局部解剖,并回顾性分析42例手术,评估其临床应用效果。结果:腔镜通道位于口腔前庭正中,两侧操作通道分别位于第一、二前磨牙间。基于紧贴下颌骨骨膜层面钝性分离三个通道的前提下,腔镜通道的切口不超过3.5 cm,以避免颏神经损伤,两侧操作通道不超过颏孔后方2 cm,以避免面动脉损伤。42例手术均获成功,早期并发症包括1例左侧下唇麻木感、1例皮肤穿孔、1例皮肤灼伤、1例通道出血。无感染、喉返神经损伤、永久性甲状旁腺功能低下等严重并发症发生。随访至2015年11月,无术后复发。结论:正确制造手术通道,缝合手术切口,丝线悬吊颈前部皮肤提供更大的空间,术后局部压迫下颌部位、精心的选择患者是避免手术相关并发症的要点。Objective：To explore the regional anatomy and its clinical application result of the surgery channels of endoscopic thyroidectomy（ ETE） via oral vestibular approach.Methods：The regional anatomy around the surgery channels was carried out on 9fixed human specimens and 42 cases of the surgery were retrospectively analyzed to evaluate its clinical application results.Results：The endoscopic channel located in the middle of oral vestibular,both of the operation channels respectively located between the first and second premolar in both sides of the oral vestibulum.Based on blunt dissecting the 3 channels before the mandible periosteum,the injury of mental nerve could be avoided if the incision length of endoscopic channel did not exceed 3.5 cm and facial artery injury could be avoided if the operation channels did not exceed 2 cm behind the mental foramen.The surgery was successfully completed in 42 cases.Of those early cases,there was 1 case of numbness on the left side of lower lip for two weeks,1 case of 0.5 cm skin perforation,1 case of small area of skin burns,1 case of postoperative bleeding in the channel.All patients had the sense of numbness around the chin in 3 d postoperatively,there was no infection,recurrent laryngeal nerve injury or permanent hypoparathyroidism.There was no recurrence with following-up to Nov.2015.Conclusions：Correctly making the operation channels and suturing the incisions,suspending the skin of the neck with silk to provide a larger space,pressure dressing on the mandible place and carefully selecting the patients are the key points to prevent the surgical-related complications.

关 键 词：甲状腺切除术 内窥镜检查 口腔前庭路径 解剖学 

分 类 号：R653[医药卫生—外科学]