甲状腺外科手术图谱

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1、甲状腺切除术手术图谱Thepatientisplacedinsemi-Fowler'spositionwiththeneckslightlyextendedandsupportedwithawaddedtoweloneachside.Acollarincisionismadefromoneposterioredgeofsternocleidomastoidtotheotheronefingerbreadthabovetheclavicleoneitherside.Thelineofincisionisimpress

2、edontheskinusingasilkligaturetoensuresymmetry图片附件:1.jpg(2005-7-818:20,8.15K)Beginninglaterally,theupperflapisbluntlydissecteduptothenotchofthethyroidcartilagewithamoistgauzeoverthethumbTheinferiorflapisdissecteddownwardoverthesternalnotchusingmostlycarefulshar

3、pdissection.Thelowerflapmaybesuturedtemporarilytotheskinofthechestandtheupperflapisheldwitharetractor.Thestrapmusclesandanteriorjugularveinsareexposedanteriorlyandthesternocleidomastoidslaterally图片附件:3.jpg(2005-7-818:22,18.38K)Thefasciaofthestrapmusclesiscaref

4、ullyincisedinthemidlineavoidingentryintothethyroidcapsule.Crossingveinsbetweenanteriorjugularsaredivided图片附件:4.jpg(2005-7-818:23,20.12K)Twofingersareusedtoelevatebothstrapmusclesoneachsidetothelevelofthethyroidlobes.Itisimportanttonotpushtoodeeplyposteriorlybe

5、foredirectvisualizationisachievedtoavoidtearingthemiddlethyroidveins.Mobilizationofthestrapsisusuallymorethansufficientforsafeexposureofevenamoderatelyenlargedgland.Foramassivegoiter,divisionofthestrapsisprudent.图片附件:5.jpg(2005-7-818:23,17.07K)Lateralretractio

6、nofthestrapsexposesthethyroidlobesandmiddlethyroidveinsoneitherside图片附件:6.jpg(2005-7-818:24,20.25K)Lateralretractionofthestrapsexposesthethyroidlobesandmiddlethyroidveinsoneitherside(2).图片附件:7.jpg(2005-7-818:24,20.3K)Thecenterofthethyroidlobeistransfixedwithah

7、eavy(2-0)figureofeightsutureandretractedmedially.Retractionofthelobebypenetratingclampsisoftenbloody,tearsthetissueandthebulkoftheinstrumentgetsintheway.Themiddlethyroidveinsarecarefullyisolatedfromtheareolarcarotidsheaths,ligatedanddivided.Mobilizationofthepo

8、steriorsurfacesisthencompletedagainusingtwofingers.Ifthoroughexplorationoftheoppositelobeisindicated,thatmiddlethyroidveinisalsodivided.图片附件:8.jpg(2005-7-818:25,20.26K)Athyroidpole