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[作为原发性甲状旁腺功能亢进症手术治疗一部分的外科解剖学研究]

[Surgical-anatomical study as a part of operative treatment of primary hyperparathyroidism].

作者信息

Nanka O, Libánsky P, Sedý J, Pozniak J, Adámek S

机构信息

III. chirurgická klinika 1. LF UK v Praze.

出版信息

Rozhl Chir. 2006 Dec;85(12):618-23.

Abstract

Surgical- anatomical studies improve experience of a surgeon and technique of the parathyroids preparation. The authors conducted a study aimed at standardization of the parathyroidectomy procedure and collection of the parathyroids from cadaverous donors for allotransplantation. The total of 101 cadavers (51 females, 50 males) were sectioned. Parathyroid regions were closely preparated, the glands were collected and histologically verified. Anatomical differences of this region were recorded. The parathyroid tissue was confirmed microscopically in 75%. Mostly, the parathyroids were mistaken for lymphonodes, a thyroid or thymus tissue. Location of inferior parathyroids was more variable (28% of inferior parathyroids is located within the thymus tissue), compared to the superior ones. Based on the study, systematic anatomical preparation in the cervical region, including a. thyroidea inferior and n. laryngeus recurrens and around the thymus cervical procesi is recommended in parathyroid procedures, where preoperative location examinations were inconclusive. Complete thymectomy with exenteration of the anterior mediastinal adipose tissue is fundamental for preparations in the mediastinum.

摘要

外科解剖学研究可提升外科医生的经验以及甲状旁腺准备技术。作者开展了一项旨在规范甲状旁腺切除术程序并从尸体供体采集甲状旁腺用于同种异体移植的研究。共解剖了101具尸体(51名女性,50名男性)。仔细解剖甲状旁腺区域,采集腺体并进行组织学验证。记录该区域的解剖差异。75%的尸体甲状旁腺组织经显微镜确认。多数情况下,甲状旁腺被误认成淋巴结、甲状腺或胸腺组织。与上位甲状旁腺相比,下位甲状旁腺的位置更具变异性(28%的下位甲状旁腺位于胸腺组织内)。基于该研究,对于术前定位检查无定论的甲状旁腺手术,建议在颈部区域进行系统的解剖准备,包括甲状腺下动脉、喉返神经以及胸腺颈部突周围。完整切除胸腺并清除前纵隔脂肪组织是纵隔准备的基础。

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