1、1234Theodor Kocher (1841-1917)瑞士伯尔尼大学外科教授,开展甲状腺外科发展的先驱。获得1909年诺贝尔医学生理学奖567意义意义89意义101112131415161718意义192021222324意义25262728293031323334353637383940 414243The neck is extended and a symmetrical,gently curved incision is made 1 to 2 cm above the clavicle.44 Upper and lower subplatysmal flaps are deve
2、loped.The deep cervical fascia is divided in the midline and the strap muscles 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.45 The thyroid lobe is retracted
3、medially and is bluntly dissected from the surrounding fascia.The middle thyroid vein is encountered and is ligated close to the thyroid.46 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 exte
4、rnal branch of the superior laryngeal nerve from damage.This nerve can be seen in many patients.47 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 art
5、ery is not ligated laterally as a single trunk.Rather,each small branch 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
6、.Another representation of removing the thyroid lobe without devascularizing the parathyroid glands.48 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 approxima
7、ted with interrupted 5-0 sutures,and the epithelium is apposed by sterile skin tapes.49甲状腺切除术治疗甲状腺肿可能较任何其他手术更能代表外科医师技艺的优异成就。50515253545556575859606162 原发细胞原发细胞 病理类型病理类型发生频度发生频度 滤泡上皮乳头状瘤滤泡状瘤未分化癌60%-70%13%-20%10%-15%滤泡旁细胞髓样癌5%-10%淋巴系细胞恶性淋巴瘤2%-3%其他磷状细胞癌极少63 临 床 特 点转 移 倾 向分类好发年龄 男女比生长速度 临床症状淋巴血行治疗后 10年生存率癌 乳 头状+少见80%-90%滤 泡 状癌20-40 岁 1 6缓 慢除 晚 期外 无 症状+45%-80%髓样癌35-40 岁 1 2.5较缓慢心 悸 腹泻压痛+80%：散 发76%、家 族92%未 分 化癌50 岁以上 1 2急速局部压迫症状全身症状强+0恶 性 淋巴瘤50 岁以上 1 2急速局部浸润压迫症状中等+少见 50%646566676869
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