环甲间隙在腔镜甲状腺手术中的重要意义

doi:10.13418/j.issn.1001-165x.2021.03.018

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中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (3) : 346-350. DOI: 10.13418/j.issn.1001-165x.2021.03.018

临床研究

环甲间隙在腔镜甲状腺手术中的重要意义

张万宇，　陈骏星，　唐世龙，　卢强，　陈展辉，　陈荣军，　齐崧旭，　陈桂星，　邱铖

作者信息 +

Significance of cricothyroid space in endoscopic thyroid surgery

Zhang Wanyu, Chen Junxing, Tang Shilong, Lu Qiang, Chen Zhanhui, Chen Rongjun, Qi Songxu, Chen Guixing, Qiu Cheng

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摘要

目的　探讨环甲间隙在颈部无瘢痕腔镜甲状腺手术（scarless in the neck endoscopic thyroidectomy，SET）中对保护喉上神经外支（external branch of superior laryngeal nerve，EBSLN）、喉返神经（recurrent laryngeal nerve，RLN）、甲状旁腺（parathyroid gland，PT）及处理甲状腺上极的重要意义。方法　回顾分析本院2014年4月至2018年7月腔镜甲状腺手术128例，包括单侧或双侧切除、次全切除或部分切除等。在处理甲状腺上极时均采用环甲间隙入路，结合甲状腺下极及外侧操作完成甲状腺叶部分或腺叶全部切除术。结果　全部SET在分离进入环甲间隙后处理甲状腺上极血管，其中59.3%（76例）显露EBSLN。在甲状腺下极区域首先显露RLN者82.8%（106例），其余17.2%在经环甲间隙入路处理甲状腺上极血管后显露RLN入喉点。术中显露UPT位于近环甲关节处者83%（106例），位于甲状腺上极背面者17%（22例）。84例随访至今，术后暂时性声音嘶哑并单侧喉返神经麻痹2例，无声音低钝及饮水呛咳者，无永久性低钙者。结论　环甲间隙在SET中对于安全切断甲状腺上极血管和有效保护EBSLN、RLN及上甲状旁腺具有重要意义，因此结合甲状腺峡部、下极及外侧操作可以形成腔镜甲状腺的程式化手术步骤，提升了该术式的安全性，有利于该术式的推广。

Abstract

Objective　To investigate the significance of the cricothyroid space in protecting external branch of superior laryngeal nerve (EBSLN), recurrent laryngeal nerve (RLN) and parathyroid gland（PT）during scarless in the neck endoscopic thyroidectomy(SET) and the importance of treating upper pole of the gland in endoscopic thyroidectomy.　Methods　A retrospective analysis was performed based on clinical information of 128 cases of scarless in the neck endoscopic thyroidectomy(SET) from April 2014 to July 2018，including unilateral or bilateral subtotal thyroidectomy and unilateral or bilateral partial thyroidectomy. The thyroid gland was partially or completely excised with the operation of upper pole of the gland through cricothyroid space combining the operation of lower pole gland and the outside of the gland.　Results　All the 128 cases were treated with the upper thyroid vessels after entering the cricothyroid space. The EBSLN were exposed in 76 cases (59.3%), the RLN were exposed in 106 cases in the lower thyroid pole at first, and the other 22 cases were exposed by the cricothyroid l thyroid space approach. UPT was found in 106 cases (83%) near the cricothyroid joint and in 22 cases (17%) on the dorsal surface of the upper pole. 84 cases were followed up to now. 2 patients had postoperative hoarseness and unilateral recurrent laryngeal nerve paralysis. There was no voice blunt, no cough when eating and drinking, or no permanent low calcium detected.　Conclusions 　The cricothyroid space plays an important role in safely severing of the superior thyroid vessels and the effectively protecting the EBSLN, the RLN and the upper parathyroid gland（UPT）in endoscopic thyroidectomy. Therefore, the surgical operation on the upper pole of thyroid gland can combine with the operation on thyroid isthmus, the lower pole and the lateral side, to form a routine surgery procedure of the endoscopic thyroid gland, which improves the safety of the operation and facilitates the popularization of the operation.

导出引用

张万宇, 陈骏星, 唐世龙, 卢强, 陈展辉, 陈荣军, 齐崧旭, 陈桂星, 邱铖. 环甲间隙在腔镜甲状腺手术中的重要意义[J]. 中国临床解剖学杂志. 2021, 39(3): 346-350 https://doi.org/10.13418/j.issn.1001-165x.2021.03.018

Zhang Wanyu, Chen Junxing, Tang Shilong, Lu Qiang, Chen Zhanhui, Chen Rongjun, Qi Songxu, Chen Guixing, Qiu Cheng. Significance of cricothyroid space in endoscopic thyroid surgery [J]. Chinese Journal of Clinical Anatomy. 2021, 39(3): 346-350 https://doi.org/10.13418/j.issn.1001-165x.2021.03.018

中图分类号： R653 R323

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