术前颈部CT对乳晕入路腔镜甲状腺手术的指导意义
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摘要
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.
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.
引文
[1]王平,项承.经胸前入路腔镜甲状腺手术专家共识(2017版)[J].中国实用外科杂志.2017,37(12):1369-1373.
[2]李开富,康骅,王亚军,等.经胸乳晕腔镜甲状腺手术的临床应用及学习曲线研究[J].实用医学杂志,2017,33(15):2514-2516.
[3]檀谊洪,杜国能,肖玉根,等.乳晕入路内镜下甲状腺切除术操作空间建立的研究[J].中国微创外科杂志,2014,14(01):29-31.
[4]宋喜亮,魏海东,郑磊,等.甲状腺结节超声特点及其Logistic回归分析[J].中国地方病防治杂志,2018,33(01):53-54.
[5]王平,谢秋萍.全腔镜甲状腺手术并发症及防治[J].中国实用外科杂志.2018,38:(6)635-642.
[6]王平,燕海潮.腔镜甲状腺手术常见问题及其对策[J].腹腔镜外科杂志,2018,23(4):245-247.
[7]孙鹏,王存川,李进义,等.乳晕入路腔镜手术治疗胸骨后甲状腺肿18例报告[J].腹腔镜外科杂志,2014,19(4):261-263.
[8]田文,张浩.甲状腺外科能量器械应用专家共识(2017版)[J].中国实用外科杂志,2017,37(9):992-997.
[9]张姣,张大奇,薛高峰,等.经口入路腔镜甲状腺手术的发展、临床应用及展望[J].中华腔镜外科杂志(电子版),2017,10(6):381-384.
[10]王平,燕海潮.腔镜下全乳晕入路甲状腺腺叶切除的方法-王氏七步法[J].中国普通外科杂志.2017,26(5):541-546.
[11]KOZOL R A,GEELHOED G W,FLYNN S D,et al.Management of ectopic thyroid nodules[J].Surgery,1993,114(6):1103-1106.
[2]李开富,康骅,王亚军,等.经胸乳晕腔镜甲状腺手术的临床应用及学习曲线研究[J].实用医学杂志,2017,33(15):2514-2516.
[3]檀谊洪,杜国能,肖玉根,等.乳晕入路内镜下甲状腺切除术操作空间建立的研究[J].中国微创外科杂志,2014,14(01):29-31.
[4]宋喜亮,魏海东,郑磊,等.甲状腺结节超声特点及其Logistic回归分析[J].中国地方病防治杂志,2018,33(01):53-54.
[5]王平,谢秋萍.全腔镜甲状腺手术并发症及防治[J].中国实用外科杂志.2018,38:(6)635-642.
[6]王平,燕海潮.腔镜甲状腺手术常见问题及其对策[J].腹腔镜外科杂志,2018,23(4):245-247.
[7]孙鹏,王存川,李进义,等.乳晕入路腔镜手术治疗胸骨后甲状腺肿18例报告[J].腹腔镜外科杂志,2014,19(4):261-263.
[8]田文,张浩.甲状腺外科能量器械应用专家共识(2017版)[J].中国实用外科杂志,2017,37(9):992-997.
[9]张姣,张大奇,薛高峰,等.经口入路腔镜甲状腺手术的发展、临床应用及展望[J].中华腔镜外科杂志(电子版),2017,10(6):381-384.
[10]王平,燕海潮.腔镜下全乳晕入路甲状腺腺叶切除的方法-王氏七步法[J].中国普通外科杂志.2017,26(5):541-546.
[11]KOZOL R A,GEELHOED G W,FLYNN S D,et al.Management of ectopic thyroid nodules[J].Surgery,1993,114(6):1103-1106.