甲狀腺疾病劉文勇

1、Theodor Kocher (1841-1917)瑞士伯爾尼大學(xué)外科教授,開展甲狀腺外科發(fā)展的先驅(qū)。獲得1909年諾貝爾醫(yī)學(xué)生理學(xué)獎(jiǎng)意義意義意義意義 The neck is extended and a symmetrical, gently curved incision is made 1 to 2 cm above the clavicle. Upper and lower subplatysmal flaps are developed. The deep cervical fascia is divided in the midline and the strap muscles

2、are retracted laterally, exposing the anterior surface of the thyroid lobe. Occasionally, in cases of large goiters, better exposure can be obtained by dividing the strap muscles transversely. The thyroid lobe is retracted medially and is bluntly dissected from the surrounding fascia. The middle thy

3、roid vein is encountered and is ligated close to the thyroid. The superior thyroid vessels are then individually ligated and divided at the level of the superior pole, rather than cephalad to it, in order to protect the external branch of the superior laryngeal nerve from damage. This nerve can be s

4、een in many patients. The thyroid lobe is retracted medially again and, by careful blunt dissection, the recurrent laryngeal nerve, the inferior thyroid artery, and the parathyroid glands are identified. The inferior thyroid artery is not ligated laterally as a single trunk. Rather, each small branc

5、h is ligated and divided at a point distal to the parathyroid glands (see arrows in insert) in order to preserve their blood supply. The thyroid lobe can then be removed from its tracheal attachments if a lobectomy is to be performed. Another representation of removing the thyroid lobe without devas

6、cularizing the parathyroid glands. Closure of the wound is accomplished by loosely approximating the strap muscles in the midline. A small suction catheter is usually inserted through a stab wound. The dermis of the flaps is approximated with interrupted 5-0 sutures, and the epithelium is apposed by

7、 sterile skin tapes. 甲狀腺切除術(shù)治療甲狀腺腫可能較任何其他手術(shù)更能代表外科醫(yī)師技藝的優(yōu)異成就。 原發(fā)細(xì)胞原發(fā)細(xì)胞 病理類型病理類型發(fā)生頻度發(fā)生頻度 濾泡上皮乳頭狀瘤濾泡狀瘤未分化癌60%-70%13%-20%10%-15% 濾泡旁細(xì)胞髓樣癌5%-10% 淋巴系細(xì)胞惡性淋巴瘤2%-3% 其他磷狀細(xì)胞癌極少 臨 床 特 點(diǎn)轉(zhuǎn) 移 傾 向分類好發(fā)年齡 男女比生長(zhǎng)速度 臨床癥狀淋巴血行治療后 10年生存率癌 乳 頭狀 +少見80%-90%濾 泡 狀癌20-40 歲 1 6緩 慢除 晚 期外 無 癥狀 +45%-80%髓樣癌35-40 歲 1 2.5較緩慢心 悸 腹瀉壓痛 + +8

8、0% ： 散 發(fā)76% 、 家 族92%未 分 化癌50 歲以上 1 2急速局部壓迫癥狀全身癥狀強(qiáng) + + 0惡 性 淋巴瘤50 歲以上 1 2急速局部浸潤(rùn)壓迫癥狀中等 +少見 50%Theodor Kocher (1841-1917)瑞士伯爾尼大學(xué)外科教授,開展甲狀腺外科發(fā)展的先驅(qū)。獲得1909年諾貝爾醫(yī)學(xué)生理學(xué)獎(jiǎng) Upper and lower subplatysmal flaps are developed. The deep cervical fascia is divided in the midline and the strap muscles are retracted laterally, exposing the anterior surface of the th