中国实用外科杂志2024，Vol.44Issue(6)：625-629,5.DOI:10.19538/j.cjps.issn1005-2208.2024.06.05
功能保护性甲状腺外科:技术难点与对策
Key technologies for function protection of important tissue and organs in thyroid surgery
摘要
Abstract
Thyroid cancer is one of the most favorable solid tumors in terms of prognosis,and surgery is the main treatment modality.Reducing postoperative complications and improving patients'quality of life after surgery are of paramount importance.Functional-protective thyroid surgery emphasizes the preservation of the physiological function of the thyroid gland itself and surrounding organs while treating thyroid diseases.To reduce postoperative bleeding and suffocation in thyroid surgery,the lower 3 cm of the subplatysma is left open and unsutured at the end of the operation to ensure a clear passage between the trachea and the loose subcutaneous tissue of the neck.The key to parathyroid function preservation is to identify and protect its blood vessels from damage during surgery.To improve the survival rate and secretory function of autologous parathyroid transplantation,autologous parathyroid transplantation with adipose tissue is recommended,and individualized parathyroid transplantation site technology is applied to improve the sensitivity of assessing the survival of the graft and the sensitivity of secretory function evaluation.In addition to the"encapsulated resection technique"and nerve monitoring instruments and other evaluation methods for recurrent laryngeal nerve function preservation,various new recurrent laryngeal nerve monitoring evaluation standards and new methods have emerged in recent years,which can more effectively evaluate the integrity of recurrent laryngeal nerve function.For cases where tumor invasion of the recurrent laryngeal nerve requires segmental resection,split-type selective vagus nerve-recurrent laryngeal nerve anastomosis can be used as a simple and effective method for repairing recurrent laryngeal nerve injury anastomosis.The clinical applicability of the suprahyoid nerve branch classification is based on the shortest distance between the lowest point of the suprahyoid nerve branch and the horizontal plane of the upper thyroid gland,providing anatomical basis and methods for the routine exposure,positioning and functional preservation of the suprahyoid nerve branch during surgery.For chylous duct function preservation,in case of accidental chylous duct injury,microsurgical repair of the chylous duct can be used as a dredging strategy in addition to direct ligation of the chylous duct and other blocking strategies.For patients with postoperative chylous leakage,the chylous leakage flow can be classified into high,medium and low flow according to the chylous leakage flow,and individualized comprehensive treatment plan can be taken to accelerate the healing of the chylous duct.关键词
甲状腺肿瘤/甲状旁腺/喉上神经外支/喉返神经/胸导管/功能保护性甲状腺外科Key words
thyroid tumor/parathyroid/external branch of superior laryngeal nerve/recurrent laryngeal nerve/thoracic duct/functional protective thyroid surgery分类
医药卫生引用本文复制引用
袁芊芊,贺青卿,田文,吴高松..功能保护性甲状腺外科:技术难点与对策[J].中国实用外科杂志,2024,44(6):625-629,5.基金项目
湖北省卫生计生委联合基金立项项目(No.WJ2015MA003,No.WJ2018H0014,No.cxpy2017068) （No.WJ2015MA003,No.WJ2018H0014,No.cxpy2017068）
湖北省自然科学基金项目(No.2008CDB179,No.2012FFB02310) （No.2008CDB179,No.2012FFB02310）
湖北省人社厅项目(No.LX1900000001) （No.LX1900000001）
