甲状腺次全切除手术入路的改进及意义

Reform of the pathway of subtotal thyroidectomy

目的 :探讨甲状腺次全切除手术入路的改进 ,提高手术治疗水平。方法 :回顾及总结 3 0 0例甲状腺次全切除术不切断舌骨下肌群、保留颈前静脉。 2 5 0例经颈白线 ,5 0例经胸锁乳突肌内侧筋膜间隙新的手术入路。结果 :全组病例术中无血管、神经损伤 ,术后无甲状腺危象 ,抽搐 ,甲低等并发症。新的手术切口Ⅰ期愈合 ,随访 4月至 5年无复发 ,术后切口平整 ,颈部活动无牵扯感。结论 :(1)甲状腺次全切除术径路的改进减少了手术创伤与出血 ,且术野显露満意 ,术后颈部活动无障碍 ,切口愈合好。 (2 )颈白线入路适应双侧甲状腺次全切除术 ,胸锁乳突肌内侧筋膜间隙入路适宜单侧甲状腺次全切除术。

Objective: To investigate the reform of the pathway of subtotal thyroidectomy to make the procedure more effective. Methods: The new pathways of subtotal thyroidectomy were summarized retrospectively from 300 cases. This surgical method can reserve superficiall anterior jugular vein and did not have to cut anterior jugular muscles. Of these cases, 250 cases underwent linea alba cericalis pathway and 50 cases adopted inboard sternociectomastoid muscle fascial space pathway. Results: No blood vessel and nerve injured, no complications of thyrotoxic crisis, hyperspasmia and hypothyroidism occurred. Jugular incision in all cases healed by first intention, no recurrence during 4-month to 5-year follow-up. Knife cut was plane and smooth, and neck can move without any restriction. Conclusions: The reform of the pathway of subtotal thyroidectomy may decrease operational trauma and intraoperative bleeding and can provide satisfactory operational fields and good incision healing while no jugular movement obstruction occurs. Linea alba cericalis pathway was suitable for bilateral subtotal thyroidectomy and inboard sternociectomastoid muscle fascial space pathway for unilateral subtotal thyroidectomy.