无充气腋窝入路完全腔镜甲状腺手术的“三推进”悬吊建腔法  

“Three-propulsion” suspension method for endoscopic thyroid surgery gasless axillary approach

作　　者：胡啸天 忻莹 郑传铭 孟可馨 葛明华 HU Xiaotian;XIN Ying;ZHENG Chuanming;MENG Kexin;GE Minghua(Medical College of Qingdao University,Qingdao 266000,Shandong Province,China;Department of Head and Neck Surgery,Center of Otolaryngology,Head and Neck Surgery,Zhejiang Provincial People’s Hospital,Affiliated People’s Hospital of Hangzhou Medical College,Hangzhou 310014,China;Zhejiang Provincial Key Laboratory of Endocrine Gland Diseases,Hangzhou 310014,China)

机构地区：[1]青岛大学青岛医学院,山东青岛266000 [2]杭州医学院附属人民医院浙江省人民医院耳鼻咽喉-头颈外科中心头颈外科,浙江杭州310014 [3]浙江省内分泌腺体疾病诊治研究重点实验室,浙江杭州310014

出　　处：《浙江大学学报（医学版）》2021年第6期694-700,共7页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省基础公益研究计划(LGC19H160001);浙江省医学会临床科研基金项目(2017ZYC-A03)。

摘　　要：无充气腋窝入路完全腔镜下甲状腺手术具有手术视野清晰、操作简便、术者学习曲线短、手术切口隐蔽以及患者术后颈部无疤痕、吞咽不适感轻微等优点。该术式由侧方入路,分离路径需经胸大肌表面、胸锁乳突肌肌间隙、颈内静脉等解剖结构,会面临颈部肌肉、血管和神经的各种变异,采用自腋窝—锁骨、锁骨—胸锁乳突肌肌间隙、胸锁乳突肌肌间隙—甲状腺三次拉钩推进,配合术中悬吊向上拉钩进行建腔的方法可以为手术操作打下良好基础。本文介绍“三推进”悬吊建腔法的主要步骤、要点及其注意事项。Gasless endoscopic thyroidectomy through unilateral axillary approach has advantages of clear vision, simple manipulation, short learning curve, hidden surgical incision, no postoperative neck scar, and less swallowing discomfort. During the procedure the separation path goes through thoracic muscle surface, sternocleidomastoid gap and jugular vein, which may meet various variations of neck muscles, blood vessels and nerves. With the “three-propulsion” suspension cavity construction method the procedure advances the dissection from the axillary incision to clavicle, from the clavicle to sternocleidomastoid gap and from the sternocleidomastoid gap to thyroid. Combined with intraoperative hanging upward hook it can establish a good cavity for the subsequent surgical operation. This article introduces the main steps, key points and attentions of the“three-propulsion” suspension cavity construction method in gasless endoscopic thyroidectomy through unilateral axillary approach.

关 键 词：甲状腺切除术 解剖异常 内窥镜 喉返神经 肩胛舌骨肌 

分 类 号：R653.2[医药卫生—外科学]