两种经口腔镜下甲状腺切除手术入路的解剖学比较研究

Anatomical study of transoral thyroidectomy

目的探讨经口入路腔镜下甲状腺切除术不同手术路径的解剖学结构,评价手术的安全性和可行性。方法对5具新鲜人体标本口底结构进行解剖,明确经口颈前正中路径(eMIT)和经口气管旁路径(TOPP)的解剖通路及其相关结构,模拟经口入路腔镜下甲状腺切除术,术后观察相关解剖结构的损伤情况。结果 eMIT经口底肌中线能够顺利到达颈前区,手术路径无重要血管、神经组织。口腔前庭切口需注意颏神经的保护。TOPP术中需注意舌下神经的保护。eMIT和TOPP均能成功实施甲状腺切除,术后解剖标本观察,无重要神经、血管等相关解剖结构损伤。TOPP手术创伤更小,但限于单侧手术,手术视野小,手术耗时(3h)较eMIT(1h)明显延长,对手术技术及器械要求较高。结论经口入路腔镜下甲状腺切除术具有解剖学的安全性和可行性,合理地选择手术路径是手术成功的关键因素。eMIT目前更适合临床推广。

Objective Endoscopic Minimally Invasive Trans-oral Thyroidectomy （eMIT） and Trans- oral Partial Parathyroidectomy（TOPP）are the two main techniques of trans-oral thyroidectomy. An anatomical study of eMIT and TOPP was made to evaluate the safety and feasibility of trans-oral thyroidectomy. Methods In this study, 5 fresh human cadavers were dissected for better understanding of the anatomic structures of the anterior cervical region, mandible region and suprahyoid bone muscles, eMIT and TOPP were subsequently performed on 2 human cadavers. Results The anterior region of neck could be easily reached through midline of the suprahyoid bone muscles by eMIT, but the upper pole of the thyroid lobe was difficult to dissected. Distinctively, TOPP set up the space at the dorsal side of the thyroid gland and adjacent to the trachea. The upper pole of the thyroid lobes, the recurrent nerve and parathyroid gland could be easily identified. The operation space was more limited in TOPP and longer surgical duration was needed for TOPP （3h） than eMIT （1h）. Special equipments and surgeons with experience were required for this technique. No injury to related muscles as well as vascular and neural structures were found by subsequent anatomical dissection. Conclusions By anatomical study, we believe that eMIT and TOPP are save and feasible. For now, eMIT is more suitable for clinical applications.