Kang Kyung Ho, Song Ra-Yeong, Suh Yong Joon, Park Sung Jun
Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
Ann Surg Treat Res. 2018 Jul;95(1):16-21. doi: 10.4174/astr.2018.95.1.16. Epub 2018 Jun 26.
The purpose of this study was to determine the extent of safety of medial dissection of the thyroid gland along the trachea. Medial to lateral dissection of the thyroid gland along the trachea after early division of the isthmus has been known to be a useful technique in thyroid surgery, especially for difficult cases, but the risk of injury of the recurrent laryngeal nerve (RLN) has constrained thyroid surgeons from utilizing this technique to its full extent.
Distances of the laryngeal entry point (LEP) of 134 RLNs of 71 patients from the midline of the trachea, and some other anatomical distances, were measured intraoperatively. The relationships of the intraoperatively measured data with circumferences of the cartilaginous portion of the trachea (CCT) around LEP measured preoperatively by CT scan were evaluated.
LEP was always located within 2 mm vertically from the horizontally extended line of the inferior border of the cricoid cartilage and was the closest point from the midline in the whole course of the RLN. The distance between LEP and the midline was very closely correlated with CCT measured on preoperative CT scan, and it can be accurately calculated with a regression equation; Distance between LEP and the midline = (0.42 × CCT) + (1.2 × sex) + 3.2 (mm) (sex: female=0, male=1; R = 0.85).
Early division of the isthmus and dissecting the thyroid off the trachea to the calculated extent is a safe and effective procedure.
本研究的目的是确定沿气管进行甲状腺内侧解剖的安全程度。已知在早期切断峡部后沿气管从内侧向外侧解剖甲状腺是甲状腺手术中的一种有用技术，特别是对于困难病例，但喉返神经（RLN）损伤的风险限制了甲状腺外科医生充分利用该技术。
术中测量了71例患者134条喉返神经的喉入口点（LEP）距气管中线的距离以及其他一些解剖学距离。评估了术中测量数据与术前通过CT扫描测量的LEP周围气管软骨部分周长（CCT）之间的关系。
LEP始终位于环状软骨下缘水平延长线垂直方向2mm范围内，并且是喉返神经全程中距中线最近的点。LEP与中线之间的距离与术前CT扫描测量的CCT密切相关，并且可以通过回归方程准确计算；LEP与中线之间的距离 =（0.42×CCT）+（1.2×性别）+ 3.2（mm）（性别：女性 = 0，男性 = 1；R = 0.85）。
早期切断峡部并将甲状腺从气管上解剖到计算出的范围是一种安全有效的手术方法。
