经腋窝后入路无充气腔镜甲状腺系膜切除术“五沉法”

"Five-settlement method" for gasless endoscopic mesothyroidexcision via unilateral axillary approach

基于大体解剖学观察及临床经验,笔者中心于2014年提出甲状腺系膜切除术概念,坚持将其用于指导甲状腺恶性肿瘤的开放甲状腺切除和中央区淋巴结清扫术,该技术的优点是能在充分保证喉返神经安全的情况下,更彻底的整块切除中央区淋巴结。近几年,经腋窝腔镜甲状腺手术在国内迅速推广,笔者中心于2019年起开展经腋窝腔镜甲状腺手术,并在前期的甲状腺系膜切除术理论指导下改良了经腋窝无充气腔镜甲状腺手术。为了更方便甲状腺外科医生掌握该技术,本文将该理论拆解并总结归纳为手术操作“五沉法”,并进行详细阐述。

Based on gross anatomical observations and clinical experience,our center proposed the concept of mesothyroid excision in 2014.We have consistently applied this technique to guide open thyroidectomy and central compartment neck dissection for malignant thyroid tumors.The advantage of this technique is its ability to achieve a more thorough en bloc removal of the central compartment lymph nodes while ensuring the safety of the recurrent laryngeal nerve.In recent years,transaxillary endoscopic thyroid surgery has been rapidly promoted in our country.Our center began performing transaxillary endoscopic thyroid surgery in 2019 and made improvements to the gasless transaxillary endoscopic thyroid surgery under the theoretical guidance of our previous mesothyroid excision technique.To facilitate thyroid surgeons in mastering this technique,this article disassembles and assembles the theory into the"five-settlement method"of surgical operation with detailed explanations.