术前颈部CT对乳晕入路腔镜甲状腺手术的指导意义

Guiding significance of preoperative neck CT for endoscopic thyroid surgery by areola(thorax)approach

目的探讨乳晕入路腔镜下甲状腺手术术前CT对手术的指导意义。方法 94例拟行乳晕入路腔镜下甲状腺手术的常规行术前颈部CT扫描,观察腺叶大小、上下极、峡部及气管等情况,与术中处理的情况进行对照。结果术前CT发现较大和上极很高的腺叶多数需分块切除和分次取出;腺叶下极和峡部位置很低的都需要充分切开胸骨上凹、游离下极;峡部宽厚和气管偏移者多需要沿着甲状软骨来识别气管。以上术前和术中结果对照的符合率分别为:83.3%(15/18)、100%(4/4)、75%(6/8)。另外发现副甲状腺1例。结论术前颈部CT扫描能为乳晕(胸部)入路腔镜下甲状腺手术提供有效的解剖信息,有助于术前和术中的决策及操作,具有很好的指导意义。

Objective To investigate the guiding significance of CT for endoscopic thyroid surgery by areola(thoracic)approach.Methods A total of 94 patients underwent routine neck CT scan before the endoscopic thyroid surgery.The size of the gland,the upper and lower poles,the isthmus and the trachea were observed and compared with the intraoperative treatment.Results Preoperative CT found that patients with large glandular lobes or very high upper pole need to be removed by segment resection,patients with lower pole of glandular lobes and isthmus need to fully cut the sternal concave;Patients with thick isthmus or trachea offset required to identify the trachea along the thyroid cartilage.The accuracy of the prediction was 83.3% (15/18),100% (4/4)and 75% (6/8),respectively.Conclusion Preoperative neck CT scan can provide effective anatomical information for endoscopic thyroid surgery by the areola(thoracic)approach,which is helpful for preoperative and intraoperative decision-making and operation,and has good guiding significance.