甲状腺切除术手术图谱

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

2、metry图片附件:1.jpg(2005-7-818:20,8.15K)Beginninglaterally,theupperflapisbluntlydissecteduptothenotchofthethyroidcartilagewithamoistgauzeoverthethumb图片附件:2.jpg(2005-7-818:21,13.29K)Theinferiorflapisdissecteddownwardoverthesternalnotchusingmostlycarefulsharpdissection.Thelowerflapmaybesuturedtemporarilyt

3、otheskinofthechestandtheupperflapisheldwitharetractor.Thestrapmusclesandanteriorjugularveinsareexposedanteriorlyandthesternocleidomastoidslaterally图片附件:3.jpg(2005-7-818:22,18.38K)Thefasciaofthestrapmusclesiscarefullyincisedinthemidlineavoidingentryintothethyroidcapsule.Crossingveinsbetweenanteriorju

4、gularsaredivided图片附件:4.jpg(2005-7-818:23,20.12K)Twofingersareusedtoelevatebothstrapmusclesoneachsidetothelevelofthethyroidlobes.Itisimportanttonotpushtoodeeplyposteriorlybeforedirectvisualizationisachievedtoavoidtearingthemiddlethyroidveins.Mobilizationofthestrapsisusuallymorethansufficientforsafeex

5、posureofevenamoderatelyenlargedgland.Foramassivegoiter,divisionofthestrapsisprudent.图片附件:5.jpg(2005-7-818:23,17.07K)Lateralretractionofthestrapsexposesthethyroidlobesandmiddlethyroidveinsoneitherside图片附件:6.jpg(2005-7-818:24,20.25K)Lateralretractionofthestrapsexposesthethyroidlobesandmiddlethyroidvei

6、nsoneitherside(2).图片附件:7.jpg(2005-7-818:24,20.3K)Thecenterofthethyroidlobeistransfixedwithaheavy(2-0)figureofeightsutureandretractedmedially.Retractionofthelobebypenetratingclampsisoftenbloody,tearsthetissueandthebulkoftheinstrumentgetsintheway.Themiddlethyroidveinsarecarefullyisolatedfromtheareolar

7、carotidsheaths,ligatedanddivided.Mobilizationoftheposteriorsurfacesisthencompletedagainusingtwofingers.Ifthoroughexplorationoftheoppositelobeisindicated,thatmiddlethyroidveinisalsodivided.图片附件:8.jpg(2