甲状腺外科手术图谱.docVIP

甲状腺切除术手术图谱The patient is placed in semi-Fowlers position with the neck slightly extended and supported with a wadded towel on each side. A collar incision is made from one posterior edge of sternocleidomastoid to the other one fingerbreadth above the clavicle on either side. The line of incision is impressed on the skin using a silk ligature to ensure symmetry 图片附件: 1.jpg (2005-7-8 18:20, 8.15 K) Beginning laterally, the upper flap is bluntly dissected up to the notch of the thyroid cartilage with a moist gauze over the thumb  The inferior flap is dissected downward over the sternal notch using mostly careful sharp dissection. The lower flap may be sutured temporarily to the skin of the chest and the upper flap is held with a retractor. The strap muscles and anterior jugular veins are exposed anteriorly and the sternocleidomastoids laterally 图片附件: 3.jpg (2005-7-8 18:22, 18.38 K) The fascia of the strap muscles is carefully incised in the midline avoiding entry into the thyroid capsule. Crossing veins between anterior jugulars are divided 图片附件: 4.jpg (2005-7-8 18:23, 20.12 K)Two fingers are used to elevate both strap muscles on each side to the level of the thyroid lobes. It is important to not push too deeply posteriorly before direct visualization is achieved to avoid tearing the middle thyroid veins. Mobilization of the straps is usually more than sufficient for safe exposure of even a moderately enlarged gland. For a massive goiter, division of the straps is prudent. 图片附件: 5.jpg (2005-7-8 18:23, 17.07 K) Lateral retraction of the straps exposes the thyroid lobes and middle thyroid veins on either side 图片附件: 6.jpg (2005-7-8 18:24, 20.25 K) Lateral retraction of the straps exposes the thyroid lobes and middle thyroid veins on either side (2). 图片附件: 7.jpg (2005-7-8 18:24, 20.3 K) The center of the thyroid lobe is transfixed with a heavy (2-0) figure of eight suture and retracted medially. Retraction of the lobe by penetrating clamps is of