经腋窝后入路无充气腔镜甲状腺系膜切除术“五沉法”
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南方医科大学南方医院 甲状腺疝外科,广东 广州 510515

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葛军娜,南方医科大学南方医院主治医师,从事甲状腺外科技术、甲状腺应用解剖学方面的研究。

基金项目:

南方医院2021年度临床研究专项基金资助项目(2021CR017);广州地区临床高新、重大和特色技术基金资助项目(2023P-TS02)。


"Five-settlement method" for gasless endoscopic mesothyroid excision via unilateral axillary approach
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Department of Thyroid & Hernia Surgery, Southern Hospital of Southern Medical University, Guangzhou 510515, China

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    摘要:

    基于大体解剖学观察及临床经验,笔者中心于2014年提出甲状腺系膜切除术概念,坚持将其用于指导甲状腺恶性肿瘤的开放甲状腺切除和中央区淋巴结清扫术,该技术的优点是能在充分保证喉返神经安全的情况下,更彻底的整块切除中央区淋巴结。近几年,经腋窝腔镜甲状腺手术在国内迅速推广,笔者中心于2019年起开展经腋窝腔镜甲状腺手术,并在前期的甲状腺系膜切除术理论指导下改良了经腋窝无充气腔镜甲状腺手术。为了更方便甲状腺外科医生掌握该技术,本文将该理论拆解并总结归纳为手术操作“五沉法”,并进行详细阐述。

    Abstract:

    Based on gross anatomical observations and clinical experience, our center proposed the concept of mesothyroid excision in 2014. We have consistently applied this technique to guide open thyroidectomy and central compartment neck dissection for malignant thyroid tumors. The advantage of this technique is its ability to achieve a more thorough en bloc removal of the central compartment lymph nodes while ensuring the safety of the recurrent laryngeal nerve. In recent years, transaxillary endoscopic thyroid surgery has been rapidly promoted in our country. Our center began performing transaxillary endoscopic thyroid surgery in 2019 and made improvements to the gasless transaxillary endoscopic thyroid surgery under the theoretical guidance of our previous mesothyroid excision technique. To facilitate thyroid surgeons in mastering this technique, this article disassembles and assembles the theory into the "five-settlement method" of surgical operation with detailed explanations.

    图1 “五沉法”中5个解剖结构—胸锁乳突肌胸骨部、颈血管鞘、食道、喉返神经和气管Fig.1 The five anatomical structures in the five-settlement method—clavicular head of sternocleidomastoid muscle, cervical vascular sheath, esophagus, recurrent laryngeal nerve and trachea
    Fig.
    图2 胸锁乳突肌锁骨部沉降 A:沉降前;B:沉降后Fig.2 Settlement of the clavicular head of sternocleidomastoid muscle A: Intraoperative view before settlement; B: Intraoperative view after settlement
    图3 颈血管鞘沉降 A:颈内静脉与颈深筋膜;B:离断颈内静脉与颈深筋膜后,显露覆盖在颈总动脉与甲状腺之间的颈深筋膜;C:离断颈总动脉与甲状腺之间的颈深筋膜Fig.3 Settlement of the carotid sheath A: Internal jugular vein and deep cervical fascia; B: Exposure of the deep cervical fascia covering between the carotid artery and thyroid gland after disconnecting the internal jugular vein from the deep cervical fascia; C: Incision of the deep cervical fascia covering the common artery and the thyroid gland
    图4 食道沉降 A:显露颈深筋膜中层;B:剪开颈深筋膜中层Fig.4 Settlement of the esophagus A: Exposure of the middle layer of the deep cervical fascia; B: Incision of the middle layer of the deep cervical fascia
    图5 喉返神经沉降 A:右侧喉返神经的裸化;B:“桥洞法”或“多孔法”游离喉返神经(左侧);C:喉返神经入喉处处理(右侧)Fig.5 Settlement of the recurrent laryngeal nerve A: Exposure of the right recurrent laryngeal nerve; B: Dissociation of the recurrent laryngeal nerve using the bridging tunnel technique or multiple pore technique (left side); C: Management of the entry of the recurrent laryngeal nerve into the larynx (right side)
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葛军娜,余诗桐,谭洁,陈伟生,李婷婷,张植诚,孙百慧,魏志刚,雷尚通.经腋窝后入路无充气腔镜甲状腺系膜切除术“五沉法”[J].中国普通外科杂志,2023,32(5):718-723.
DOI:10.7659/j. issn.1005-6947.2023.05.011

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  • 收稿日期:2023-01-14
  • 最后修改日期:2023-05-06
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  • 在线发布日期: 2023-06-03