腔镜甲状腺外科手术的精细化操作技术  

Meticulous surgical techniques for endoscopic thyroid surgery

作　　者：王斌 仇明 WANG Bin;QIU Ming(Department of Thyroid Breast Hernia Surgery,Chang Zheng Hospital,Naval Military Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学长征医院甲乳疝外科,上海200003

出　　处：《外科理论与实践》2023年第3期197-201,共5页Journal of Surgery Concepts & Practice

摘　　要：甲状腺外科手术的精细化已成为甲状腺外科治疗的规范要求和技术水平提升的标志。腔镜设备将手术视野高清放大后,更有利于术中的精细化操作。本文根据腔镜甲状腺外科手术的技术要点,从腔镜操作空间建立、甲状腺瘤体显露、关键器官及组织的保护等方面探讨精细化操作的要点。腔镜操作空间建立方面,皮下分离层面尽可能达到“天红地黄”,即颈阔肌与浅筋膜深层之间的间隙,分离面积呈“长隧道,小腔隙”,从两侧胸锁关节至两侧乳晕呈“细颈宽底”的扇形。甲状腺瘤体显露方面,颈前肌群充分游离和牵拉是显露甲状腺腺体的关键技术,充分游离3个间隙[正中间隙(颈白线间隙)、内间隙(甲状腺外科被膜与颈前肌群的间隙)和外间隙(颈前肌群与胸锁乳突肌的间隙)],同时专用缝线或拉钩辅助,充分游离颈前间隙,用合理的抓持腺体方式及合适的能量平台预防甲状腺出血。保护关键器官及组织方面,神经监测技术有助于寻找和定位喉返神经,并在入喉处精细操作,避免神经的副损伤;淋巴负显影技术辅助识别甲状旁腺。同时术中仔细辨认甲状旁腺的解剖类型,精细解剖甲状旁腺的膜间隙,更有助于原位保护甲状旁腺的血供。实现手术精细化和微创化,需改良手术器械和材料,但更重要的是外科医师更新手术理念,熟识解剖关系,不断打磨手术技巧。The refinement of thyroid surgery has become a standardized requirement and a symbol of improved technical level in thyroid surgery.Endoscopic equipment magnifies the surgical field of view in high definition,making it more conducive to perform the surgery meticulously.Here we explored the key points of refined surgery based on the technical points of endoscopic thyroid surgery.We also focused on the establishment of endoscopic operation space,exposure of thyroid tumors,and protection of key organs and tissues.With regard to the establishment of endoscopic operation space,the separation of subcutaneous layer should show the view of“red sky and yellow ground”,which means the gap between the platysma muscle and the deep layer of the superficial fascia.The subcutaneous dissection area should be present as“long tunnel,small cavity”,and the shape from the bilateral sternoclavicular joints to the bilateral areola,which seems like the fan-shape with“thin neck and wide bottom”.With regard to the exposure of thyroid tumors,the key technical points include the dissociating and traction of anterior cervical muscles.Three spaces [the median space(the white line space of the neck),the inner space(the space between the thyroid surgical capsule and the anterior cervical muscles) and the outer space(the space between the anterior cervical muscles and the sternocleidomastoid muscle)] need to be fully dissociated.Furthermore,the assistant with special sutures or hooks to fully dissociate the anterior cervical space and the use of a reasonable grasping method as well as a suitable energy platform to prevent thyroid bleeding.With regard to the protection of key organs and tissues,nerve monitoring technology helps to find and locate the recurrent laryngeal nerve.In addition,careful manipulation at the entrance to the larynx is the key to avoid the damage of recurrent laryngeal nerve.Lymph negative imaging technology helps to identify the parathyroid gland.Accurate identification of the anatomical type of the parathyroid g

关 键 词：甲状腺手术 腔镜 喉返神经 甲状旁腺 

分 类 号：R653[医药卫生—外科学]