Zuckerkandl结节在甲状腺外科中的重要意义
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摘要
目的探讨Zuckerkandl结节(Zuckerkandl’s tubercle,ZT)在甲状腺手术中出现的机率,以及ZT与喉返神经(recurrent laryngeal nerve,RLN)、上甲状旁腺(superior parathyroid gland,SPG)的解剖关系。方法回顾分析2016年12月至2017年12月,在赣南医学院第一附属医院耳鼻咽喉-头颈外科住院施行单侧或双侧甲状腺腺叶切除的120例甲状腺肿瘤患者的病历资料。对146个腺叶进行记录,观察ZT,分析其与RLN、SPG的解剖关系。结果 76例(63.3%)患者发现ZT,而54例(45.0%)患者其结节最长径大于1 cm。ZT较大者,87例(92.6%)RLN在ZT内侧,7例(7.4%)RLN横过ZT。SPG通常位于ZT之上,RLN之后。结论 ZT是甲状腺的显著特征之一,多数甲状腺手术中可以发现。ZT的大小和位置与术前症状没有确切的关系。理解ZT与RLN和SPG的解剖关系,对甲状腺手术的安全性具有重要意义。
Objective To study the occurrence rate of tubercle of Zuckerkandl(ZT) in thyroid surgery and the anatomic relationship between ZT and recurrent laryngeal nerve(RLN) and superior parathyroid gland(SPG). Methods Data of 120 patients with thyroid tumor underwent unilateral or bilateral thyroid gland lobe resection in the department of otolaryngology-head and neck surgery of the first affiliated hospital of Gannan medical college between December 2016 to December 2017 were retrospectively analyzed. One hundred and forty six glandular lobes were recorded, ZT was analyzed and the size of ZT was measured. The relationship between ZT and recurrent laryngeal nerve and superior parathyroid gland was observed. Results ZT was identified in 76 cases(63.3%) of patients and its longest diameter was >1 cm in 54 cases(45.0%). In 87 cases(92.6%) of patients with an enlarged ZT, the RLN laid medial to it and the nerve was found lateral to the ZT in 7 cases(7.4%). The SPG was usually cranial to the ZT and posterior to the recurrent laryngeal nerve. Conclusions ZT is a distinct feature of the thyroid gland that can be recognized during most thyroidectomies. The size and position of the ZT have no constant relationship to preoperative symptoms. An understanding of the consistent anatomical relationship between the ZT and RLN and SPG is crucial for safe thyroidectomy.
Objective To study the occurrence rate of tubercle of Zuckerkandl(ZT) in thyroid surgery and the anatomic relationship between ZT and recurrent laryngeal nerve(RLN) and superior parathyroid gland(SPG). Methods Data of 120 patients with thyroid tumor underwent unilateral or bilateral thyroid gland lobe resection in the department of otolaryngology-head and neck surgery of the first affiliated hospital of Gannan medical college between December 2016 to December 2017 were retrospectively analyzed. One hundred and forty six glandular lobes were recorded, ZT was analyzed and the size of ZT was measured. The relationship between ZT and recurrent laryngeal nerve and superior parathyroid gland was observed. Results ZT was identified in 76 cases(63.3%) of patients and its longest diameter was >1 cm in 54 cases(45.0%). In 87 cases(92.6%) of patients with an enlarged ZT, the RLN laid medial to it and the nerve was found lateral to the ZT in 7 cases(7.4%). The SPG was usually cranial to the ZT and posterior to the recurrent laryngeal nerve. Conclusions ZT is a distinct feature of the thyroid gland that can be recognized during most thyroidectomies. The size and position of the ZT have no constant relationship to preoperative symptoms. An understanding of the consistent anatomical relationship between the ZT and RLN and SPG is crucial for safe thyroidectomy.
引文
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[2]Mansberger AR Jr,Wei JP.Surgical embryology and anatomy of the thyroid and parathyroid glands[J].Surg Clin North Am,1993,73(4)727-746.
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[4]余济春.甲状腺手术技巧[J].中国耳鼻咽喉头颈外科,2007,14(6):338-340.
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[6]刘家锋,余济春,彭韶平,等.环甲间隙入路甲状腺手术效果观察[J].实用医学杂志,2010,26(23):4383-4385.
[7]刘家锋,赖华英,彭韶平,等.环甲间隙入路甲状腺手术对喉上神经的识别与保护的意义[J].中国医学创新,2016,13(35):16-20.
[8]Pelizzo MR,Toniato A,Gemo G.Zuckerkandl's tuberculum:an arrow pointing to the recurrent laryngeal nerve(constant anatomical landmark)[J].J Am Coll Surg,1998,187(3):333-336.
[9]Chevallier JM,Martelli H,Wind P.Surgical discovery of parathyroid glands and the recurrent laryngeal nerve.Application of well known embryological concepts in the operating room[J].Ann Chir,1995,49(4):296-304.
[10]Gilmour JR.The gross anatomy of the parathyroid glands[J].J Pathol Bacteriol,1938,46(1):133-149.
[11]Hisham AN,Aina EN.Zuckerkandl's tubercle of the thyroid gland in association with pressure symptoms:a coincidence or consequence[J].Aust N Z J Surg,2015,70(4):251-253.
[12]Larsen W,Ls S,Ss P,et al.Human embryology[M].New York:Churchill Livingstone,1997,345-410.
[13]Proye C.La lobectomie totale technique protection du nerf re′current,du nerf larynge′superior et des parathyroids[A].Actualite′s Chirurgicales 82nd Congress Francais de Chirurgie 1983,III:45.
[14]Mérida-Velasco JA,García-García JD,Espín-Ferra J,et al.Origin of the ultimobranchial body and its colonizing cells in human embryos[J].Acta Anat(Basel),1989,136(4):325-330.
[15]Moore KL.The developing human:clinically oriented embryology[M].4th ed.Philadelphia:W.B.Saunders,1993,170-206.
[16]Reeve TS,Delbridge L,Cohen A,et al.Total thyroidectomy.The preferred option for multinodular goiter[J].Ann Surg,1987,206(6):782-786.
[17]Williams ED,Toyn CE,Harach HR.The ultimobranchial gland and congenital thyroid abnormalities in man[J].J Pathol,1989,159(2):135-141.
[2]Mansberger AR Jr,Wei JP.Surgical embryology and anatomy of the thyroid and parathyroid glands[J].Surg Clin North Am,1993,73(4)727-746.
[3]Wang C.The use of the inferior cornu of the thyroid cartilage in identifying the recurrent laryngeal nerve[J].Surgery Gynecol Obstet,1975,140(1):91-94.
[4]余济春.甲状腺手术技巧[J].中国耳鼻咽喉头颈外科,2007,14(6):338-340.
[5]Delbridge L,Reeve TS,Khadra M,et al.Total thyroidectomy:the technique of capsular dissection[J].Aust N Z J Surg,1992,62(2):96-99.
[6]刘家锋,余济春,彭韶平,等.环甲间隙入路甲状腺手术效果观察[J].实用医学杂志,2010,26(23):4383-4385.
[7]刘家锋,赖华英,彭韶平,等.环甲间隙入路甲状腺手术对喉上神经的识别与保护的意义[J].中国医学创新,2016,13(35):16-20.
[8]Pelizzo MR,Toniato A,Gemo G.Zuckerkandl's tuberculum:an arrow pointing to the recurrent laryngeal nerve(constant anatomical landmark)[J].J Am Coll Surg,1998,187(3):333-336.
[9]Chevallier JM,Martelli H,Wind P.Surgical discovery of parathyroid glands and the recurrent laryngeal nerve.Application of well known embryological concepts in the operating room[J].Ann Chir,1995,49(4):296-304.
[10]Gilmour JR.The gross anatomy of the parathyroid glands[J].J Pathol Bacteriol,1938,46(1):133-149.
[11]Hisham AN,Aina EN.Zuckerkandl's tubercle of the thyroid gland in association with pressure symptoms:a coincidence or consequence[J].Aust N Z J Surg,2015,70(4):251-253.
[12]Larsen W,Ls S,Ss P,et al.Human embryology[M].New York:Churchill Livingstone,1997,345-410.
[13]Proye C.La lobectomie totale technique protection du nerf re′current,du nerf larynge′superior et des parathyroids[A].Actualite′s Chirurgicales 82nd Congress Francais de Chirurgie 1983,III:45.
[14]Mérida-Velasco JA,García-García JD,Espín-Ferra J,et al.Origin of the ultimobranchial body and its colonizing cells in human embryos[J].Acta Anat(Basel),1989,136(4):325-330.
[15]Moore KL.The developing human:clinically oriented embryology[M].4th ed.Philadelphia:W.B.Saunders,1993,170-206.
[16]Reeve TS,Delbridge L,Cohen A,et al.Total thyroidectomy.The preferred option for multinodular goiter[J].Ann Surg,1987,206(6):782-786.
[17]Williams ED,Toyn CE,Harach HR.The ultimobranchial gland and congenital thyroid abnormalities in man[J].J Pathol,1989,159(2):135-141.