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浙江大学学报(医学版)  2021, Vol. 50 Issue (6): 701-706    DOI: 10.3724/zdxbyxb-2021-0341
专题报道     
颈侧方切口甲状腺手术的步骤及要点
邬一军1,*,朱峰1,沈亦斌1,方云1,朱丽娴1,何琦文1,潘俊1,陈凌慧1,田文2
1.浙江大学医学院附属第一医院甲状腺外科,浙江 杭州 310003
2.中国人民解放军总医院第一医学中心甲状腺疝外科,北京 100853
The steps and key points of thyroid surgery with lateral cervical incision
WU Yijun1,*,ZHU Feng1,SHEN Yibin1,FANG Yun1,ZHU Lixian1,HE Qiwen1,PAN Jun1,CHEN Linghui1,TIAN Wen2
1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;
2. Department of Thyroid and Hernia Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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摘要:

颈侧方切口甲状腺手术采用颈侧方切口,利用胸锁乳突肌胸骨头与锁骨头肌间的天然解剖间隙作为入路,从带状肌与颈动脉鞘之间进入甲状腺术区,首先辨识喉返神经及上下位甲状旁腺,离断上极血管,再分离Berry韧带,离断峡部,最后切除甲状腺。该手术可以避免传统手术对颈前区皮肤肌肉组织的创伤,患者术后颈部压迫感和吞咽牵拉感明显缓解。颈侧方切口甲状腺手术操作快捷,临床效果良好。本文介绍如何规范化地操作及手术注意事项等,以期更好普及推广。

关键词: 颈侧方切口胸锁乳突肌肌间入路甲状腺手术颈前区功能保护手术要点    
Abstract:

The thyroid surgery with lateral cervical incision uses the sternocleidomastoid intermuscular approach through the gap between band muscles and carotid sheath to reach the surgical field. The recurrent laryngeal nerve and upper and lower parathyroid glands are first identified, the upper pole vessels are severed; then the Berry ligament is separated; the isthmus is severed, and the thyroid gland is finally removed. This approach can avoid the trauma of the skin and muscle tissue in the anterior neck region, to relieve the pressure on the neck and swallowing stretch feeling for patients after surgery. The surgical modality is effective and less time-consuming. This article gives a detailed introduction to the standardized procedures and some key points of thyroid surgery with lateral cervical incision.

Key words: Lateral cervical incision    Sternocleidomastoid intermuscular approach    Thyroid surgery    Anterior cervical function protection    Surgery points
收稿日期: 2021-10-07 出版日期: 2022-03-22
基金资助: 浙江省自然科学基金(LQ20H160023)
通讯作者: 邬一军   
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引用本文:

邬一军,朱峰,沈亦斌,方云,朱丽娴,何琦文,潘俊,陈凌慧,田文. 颈侧方切口甲状腺手术的步骤及要点[J]. 浙江大学学报(医学版), 2021, 50(6): 701-706.

WU Yijun,ZHU Feng,SHEN Yibin,FANG Yun,ZHU Lixian,HE Qiwen,PAN Jun,CHEN Linghui,TIAN Wen. The steps and key points of thyroid surgery with lateral cervical incision. J Zhejiang Univ (Med Sci), 2021, 50(6): 701-706.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0341        https://www.zjujournals.com/med/CN/Y2021/V50/I6/701

图 1  颈侧方切口甲状腺手术胸锁乳突肌肌间入路切口标记及术后愈合外观A:颈侧方切口胸锁乳突肌肌间入路(沿颈纹标记)与传统切口对比;B:颈侧方切口沿项链标记;C:术后1个月颈侧方切口愈合情况;D:术后1个月颈侧方切口项链的遮挡效果. 黑色箭头指示切口所在位置.
图 2  颈侧方切口甲状腺手术入路空间的建立A:分离胸锁乳突肌肌间隙;B:分离肩胛舌骨肌带状肌肌间隙;C:显露甲状腺后外侧.
图 3  颈侧方切口甲状腺手术喉返神经的定位及分离A:颈鞘前方探测V1信号;B:全程暴露喉返神经至入喉处;C:带有光源和吸引功能的长横臂拉钩维持手术空间稳定.
图 4  颈侧方切口甲状腺手术甲状腺上极的处理A:暴露并原位保留上位甲状旁腺;B:监测喉上神经;C:离断甲状腺上极血管.
图 5  颈侧方切口甲状腺手术Berry韧带和喉前区的处理A:分离Berry韧带;B:分离甲状腺与气管间间隙至气管对侧.
图 6  颈侧方切口甲状腺手术甲状腺下极的处理和峡部的离断A:辨认并分离下位甲状旁腺;B:沿峡部切除甲状腺.
图 7  颈侧方切口甲状腺手术中央淋巴结的清扫A:沿喉返神经清扫患侧中央淋巴结;B:淋巴结清扫后区域.
1 LOMBARDIC P, RAFFAELLIM, DE CREAC, et al.Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms[J]Surgery, 2009, 146( 6): 1174-1181.
doi: 10.1016/j.surg.2009.09.010
2 邬一军, 朱 峰. 重视甲状腺手术颈前区功能的保护[J]. 中华内分泌外科杂志, 2020, 14(4): 265-268
WU Yijun, ZHU Feng. Significance of protection of anterior cervical function in thyroid surgery[J]. Chinese Journal of Endocrine Surgery, 2020, 14(4): 265-268. (in Chinese)
3 NGUYEN J D, DUONG H. Anatomy, head and neck, sternohyoid muscle[A/OL]. (2021-07-26)[2020-10-07]. https://www.ncbi.nlm.nih.gov/books/NBK547693/
4 朱 峰, 邬一军, 沈亦斌, 等. 经胸锁乳突肌肌间入路行甲状腺手术对颈前区功能保护研究[J]. 中国实用外科杂志, 2020, 40(7): 847-850
ZHU Feng, WU Yijun, SHEN Yibin, et al. Functional protection of anterior cervical region by thyroid surgery with sternocleidomastoid intermuscular approach[J]. Chinese Journal of Practical Surgery, 2020, 40(7): 847-850. (in Chinese)
5 ARORAA, SWORDSC, GARASG, et al.The perception of scar cosmesis following thyroid and parathyroid surgery: a prospective cohort study[J]Int J Surg, 2016, 38-43.
doi: 10.1016/j.ijsu.2015.11.021
6 JEONM K, KANGS J, SUNH. Platysma flap with z-plasty for correction of post-thyroidectomy swallowing deformity[J]Arch Plast Surg, 2013, 40( 4): 425.
doi: 10.5999/aps.2013.40.4.425
7 LOMBARDIC P, RAFFAELLIM, D’ALATRIL, et al.Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries[J]Surgery, 2006, 140( 6): 1026-1034.
doi: 10.1016/j.surg.2006.08.008
8 GOHRBANDTA E, ASCHOFFA, GOHRBANDTB, et al.Changes of laryngeal mobility and symptoms following thyroid surgery: 6-month follow-up[J]World J Surg, 2016, 40( 3): 636-643.
doi: 10.1007/s00268-015-3323-y
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