甲状腺下极动静脉的临床解剖与改良的气管切开术安全性探讨

发布时间：2018-06-22 03:10

本文选题：甲状腺 + 动脉　；参考：《临床耳鼻咽喉头颈外科杂志》2017年23期

【摘要】：目的:探讨甲状腺下极动静脉的临床解剖与改良的气管切开术安全性。方法:选取60例需要做腺叶切除或全切的甲状腺癌患者、50例需要做气管切开的喉癌或下咽癌患者,在不损害患者利益的前提下解剖与气管切开密切相关的甲状腺下极动静脉。根据解剖结果对倒"U"型气管瓣气管切开术进行改良,最后将进一步改良的气管切开方法用于临床,与我科之前报道的倒"U"型气管瓣气管切开术及常规的气管切开术进行比较。结果:110例患者中发现有甲状腺最下动脉分布11例(10%),甲状腺下静脉一般有2~4支,在气管前间隙内下行,起于甲状腺侧叶下极或峡。甲状腺下极血管分型:静脉单干型28例;静脉双干无交通型43例;静脉双干有交通型28例;混合型11例。进一步改良的气管切开方法可有效避免甲状腺下极动静脉再出血。该方法用于临床,目前无一例出血,无其他并发症发生。结论:气管切开密切相关的甲状腺下极动静脉的临床解剖,为进一步改良的气管切开安全提供临床依据;进一步改良的气管切开术比倒"U"型气管瓣气管切开术及常规的气管切开术具有一定的优势,不仅操作简单、容易推广,更重要的是安全性大大提高。
[Abstract]:Objective: to investigate the clinical anatomy and safety of modified tracheotomy of inferior thyroid artery and vein. Methods: fifty patients with laryngeal or hypopharyngeal carcinoma who needed tracheotomy were selected from 60 patients with thyroid cancer who needed to be treated with lobectomy or total resection of thyroid gland. The inferior thyroid arteries and veins closely related to tracheotomy were dissected without prejudice to the interests of the patients. According to the anatomical results, the tracheostomy of inverted "U" valve was improved. Finally, the further improved tracheotomy method was applied in clinic, and compared with the "U" type valve tracheotomy and the routine tracheotomy. Results of 110 patients, 11 (10%) were found to have the inferior thyroid artery, and there were 24 inferior thyroid veins, which began at the inferior lobe or isthmus of the thyroid gland in the anterior space of trachea. There were 28 cases of single trunk type of vein, 43 cases of non-communicating type of double trunk of vein, 28 cases of communicating type of double trunk of vein and 11 cases of mixed type. Further improved tracheotomy can effectively avoid rebleeding at the lower extremity of thyroid. There was no bleeding and no other complications. Conclusion: the clinical anatomy of closely related inferior thyroid arteriovenous tracheotomy provides the clinical basis for the further improvement of tracheotomy safety. The further improved tracheotomy has some advantages over the inverted "U" valve tracheotomy and conventional tracheotomy. It is not only simple, easy to popularize, but also more important, the safety is greatly improved.
【作者单位】：安徽医科大学第一附属医院耳鼻咽喉头颈外科;
【基金】：安徽省2015科技攻关计划项目(No:1501041147)
【分类号】：R653

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