甲状腺疾病刘文勇.pptxVIP

甲状腺疾病;甲状腺的解剖生理概要;掌握甲状腺解剖的重要性;;甲状腺形态;甲状腺位置;甲状腺位置异常;甲状腺的被膜;甲状腺的手术层次;甲状腺的固定;甲状腺的血管;意义;甲状腺上动脉与喉上神经;;预防喉上神经损伤;甲状腺下动脉与喉返神经;预防喉返神经损伤;甲状旁腺;预防甲状旁腺损伤;甲状腺的生理功能;甲状腺素的合成; 意义;甲状腺素的主要作用;甲状腺检查法;甲状腺疾病;甲状腺功能亢进症;甲状腺功能亢进症;临床表现;诊断;外科手术适应症;术前准备;手术时机： 症状缓解、心率小于90次、基础代 谢率在＋20％以下 。 手术切除范围： （a） 双叶甲状腺大部切除术。 （b）一叶甲状腺全切+对侧大部切除。 切除要求：切除甲状腺组织的79%--90%。;甲状腺手术;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 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 thyroid 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 seen 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 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. Another representation of removing the thyroid lobe without devascularizing the parathyroid glands. ; Closure of the wound is accomplished by loosely approximating the strap muscles in the midline. A small suction catheter is usually i