一个新的甲状腺手术麻醉点的解剖学基础及临床应用

Anatomic basis and clinical application of a new anesthetic point on thyrotomy

目的：为甲状腺手术提供新的麻醉方法。方法：用３０侧成人标本，在手术显微镜下观察了颈前部神经的来源、分支分布及其吻合。结果：颈皮神经分单干，上、下干和上、中、下干三种类型。上、中、下干的起始宽度分别为１．６±０．６ｍｍ，１．８±０．６ｍｍ和１．８±０．７ｍｍ；干长１７．７±７．８ｍｍ，３１．７±１２．３ｍｍ和２５．４±９．０ｍｍ。锁骨上内侧神经分布至胸锁关节和胸骨柄上方的皮肤。面神经颈支的降支均与颈皮神经吻合。明确了通过胸锁乳突肌前缘，甲状软骨上缘下方１．５ｃｍ与颈前正中线外侧４ｃｍ的交点处（麻醉点）１ｃｍ和２ｃｍ半径圆形区的神经来源和分布。结论：经临床１００例应用验证新麻醉点具有安全可靠、效果理想、并发症少等特点。

Objective:To provide a new anesthetic method for the thyrotomyMethods:The origins,branch distribution and anastomosis of the nerves in anterior jugular areas were observed on 30 sides of adult cadaver specimens under operative microscopeResults:There were three types of cutaneous nerve in the neck area:type Ⅰ,a single trunk; type Ⅱ,a superior and an inferior trunks;and type Ⅲ a superior,a middle and an inferior trunksThe medial superiaclavicular nerve was distributed to the skin of thoracoclavicular joint and the manubrium of sternumAnd the descending branches of the jugular branches of facial nerve anastomosed with the jugular cutaneous nerveA cycle with a radius of 1 cm or 2 cm,whose the center was the cross point of 15 cm under the thyroid cartilage and 4 cm lateral to the anterior median line,was chosen as the new anesthetic pointConclusions:It is testified that the new anesthetic point is secure,effective and few complications by 100 cases clinical application