甲状腺下极动静脉的临床解剖与改良的气管切开术安全性探讨

The clinical anatomy of the inferior thyroid arteries and veins and the safety of the modified tracheotomy

目的:探讨甲状腺下极动静脉的临床解剖与改良的气管切开术安全性。方法:选取60例需要做腺叶切除或全切的甲状腺癌患者、50例需要做气管切开的喉癌或下咽癌患者,在不损害患者利益的前提下解剖与气管切开密切相关的甲状腺下极动静脉。根据解剖结果对倒"U"型气管瓣气管切开术进行改良,最后将进一步改良的气管切开方法用于临床,与我科之前报道的倒"U"型气管瓣气管切开术及常规的气管切开术进行比较。结果:110例患者中发现有甲状腺最下动脉分布11例(10%),甲状腺下静脉一般有2~4支,在气管前间隙内下行,起于甲状腺侧叶下极或峡。甲状腺下极血管分型:静脉单干型28例;静脉双干无交通型43例;静脉双干有交通型28例;混合型11例。进一步改良的气管切开方法可有效避免甲状腺下极动静脉再出血。该方法用于临床,目前无一例出血,无其他并发症发生。结论:气管切开密切相关的甲状腺下极动静脉的临床解剖,为进一步改良的气管切开安全提供临床依据;进一步改良的气管切开术比倒"U"型气管瓣气管切开术及常规的气管切开术具有一定的优势,不仅操作简单、容易推广,更重要的是安全性大大提高。

Objective：To evaluated the clinical anatomy of the inferior thyroid arteries and veins and the safety of clinical application of the modified tracheotomy.Method：Sixty patients who need partial resection or full resection of thyroid cancer and 50 patients with laryngeal or hypopharyngeal cancer required tracheotomy were enrolled in this study.The distribution of the inferior thyroid arteries and veins closely related to tracheotomy is further dissected.The inverted ＂ U＂ type of tracheal flap tracheotomy was further improved based on anatomical findings.Finally,the further modified tracheotomy was used for clinical practice and compared with the conventional tracheotomy and the inverted ＂ U＂ type of tracheal flap tracheotomy.Result：Of the 110 cases,the lowest thyroid artery was found in 11 cases,with a rate of 10%.The inferior thyroid vein has 2-4 branches,which originates from the lower lobe or isthmus of the thyroid lateral lobe,descending in the anterior tracheal space.According to the characteristics of the static reflux of the thyroid gland,the lower thyroid vessels are classified into four types：intravenous dry type（28 cases）;intravenous double dry without traffic type（43 cases）;intravenous double trunk with traffic（28 cases）;mixed type（11 cases）.At present,the further modified tracheotomy can effectively avoid the rebleeding of the lower thyroid arteries and veins.There were no bleeding and other complications in all cases.Conclusion：It provides a basis for the further modified of tracheotomy based on the clinical anatomy of the inferior thyroid artery and vein,which is closely related to tracheotomy.The further modified tracheotomy has certain advantages than the conventional tracheotomy and the inverted ＂ U＂ type of tracheal flap tracheotomy.