Surgeon's approach to the thyroid gland: Surgical anatomy and the importance of technique
Surgeon's approach to the thyroid gland: Surgical anatomy and the importance of technique
复制标题
DOI：
10.1007/s002680010173
复制
发表时间：
2000-08-01
影响因子：
2.6
通讯作者：
Delbridge, LW
中科院分区：
文献类型：
--
作者：
Bliss, RD;Gauger, PG;Delbridge, LW
安全有效的甲状腺手术的基石是对甲状腺解剖和病理的透彻培训和了解，结合适当的技术，可以在最大限度地减少对喉返神经、喉上神经外支和甲状旁腺的损害的风险下进行甲状腺全切除术和全甲状腺切除术(仅应被认为是在同一手术中进行的双侧甲状腺全切除术)。安全的手术需要一个具体的手术计划，按照一系列符合逻辑的、有序的、基于解剖学的步骤进行，显露甲状腺之后仔细解剖上极，利用上极和环甲肌之间的无血管平面来识别和保留喉上神经的外部分支。腺体内侧回缩可以剥离甲状腺叶外侧，保护喉返神经，保存甲状旁腺的血液供应，最好的方法是“包膜剥离”，在腺体表面结扎甲状腺下动脉的三级分支。如果甲状旁腺不能保留或血管蒂剥离后变得缺血，应立即切碎并自体移植到同侧胸锁乳突肌。目前门诊或短期甲状腺切除术的发展强调了通过使用细致的手术技术来避免并发症的必要性。使用内窥镜技术的微创甲状腺切除术也可能影响甲状腺手术的实践。即便如此，了解甲状腺的外科解剖及其可能的变异对于安全有效的手术是至关重要的。
The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology, With appropriate techniques, total thyroid lobectomy and total thyroidectomy (which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation) can be undertaken with minimal risk of damage to the recurrent laryngeal nerves, the external branches of the superior laryngeal nerves, and the parathyroid glands. Safe surgery requires a specific operative plan, progressing in a series of logical, orderly, anatomically based steps, Exposure of the thyroid gland is followed by careful dissection of the superior pole, utilizing the avascular plane between the superior pole and the cricothyroid muscle to identify and preserve the external branch of the superior laryngeal nerve. Medial retraction of the gland then allows dissection of the lateral aspect of the thyroid lobe, Protection of the recurrent laryngeal nerves and preservation of the blood supply to the parathyroid glands is best achieved by "capsular dissection," ligating the tertiary branches of the inferior thyroid artery on the gland surface. If a parathyroid gland cannot be preserved or becomes ischemic after dissection of its vascular pedicle, it should be immediately minced and autotransplanted into the ipsilateral sternocleidomastoid muscle. The current evolution of outpatient or short-stay thyroidectomy emphasizes the need to avoid complications by utilizing meticulous surgical technique. Minimally invasive thyroidectomy utilizing endoscopic techniques may also affect the practice of thyroid surgery. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount to safe and effective surgery.