腔镜甲状腺手术中Berry韧带区解剖标志的研究

Precise anatomy near ligament of Berry in the view of endoscopic thyroidectomy

目的研究腔镜甲状腺术中最容易出血及发生并发症Berry韧带区域，探索程序化的腔镜甲状腺手术思路。方法对2011年1～12月福建医科大学附属协和医院256例346侧腔镜甲状腺手术录像进行回顾性分析，分析并记录影响腔镜甲状腺手术过程的血管及其与神经的关系。结果在由下向上的腔镜甲状腺手术中，存在2个动脉和喉返神经交叉层面解剖标志，分别为甲状腺下动脉（inferiorthyroidartery，ITA）层面及上旁腺动脉（parathyroidglandartery，PGA）层面，ITA层面u型牵拉的出现率左侧为75．18％，右侧为82．78％；PGA层面u型牵拉的出现率左侧为52．6％，右侧为74．2％。结论腔镜甲状腺手术中，ITA和PGA两个动脉和喉返神经交叉层面是腔镜视野下甲状腺手术的重要标志结构，手术中对ITA和PGA两个动脉层面的松解是保护喉返神经和保护甲状旁腺血供的关键步骤。

Objective To study the anatomy near ligament of Berry in the View of Endoscopic Thyroidectomy, discuss the programmed endoscopic thyroid surgery. Methods From 346 side＇s endoscopic Thyroid lobectomies were analyzed retrospectively, important structural which restriction Thyroid lobectomy and its relationship with recurrent laryngeal nerve were analyzed. Results From the view of endoscopic thyroid lobectomy, ITA and PGA two artery layers were identified, these anatomic landmarks appears rates were 75.2% ,52.6% in the left and 82.8% ,74.2% in the right, Respectively. Conclusion ITA layer and PGA layer often leads to U-shaped stretch to the Recurrent laryngeal nerve, these anatomical landmarks are helpful to the protection of the recurrent laryngeal nerve and the artery of superior parathyroid gland.