The retroesophageal right subclavian artery may be associated with multiple neurovascular variations, which may impact various cervicothoracic surgeries. During the dissection of 27 cadavers, the authors detected a re...The retroesophageal right subclavian artery may be associated with multiple neurovascular variations, which may impact various cervicothoracic surgeries. During the dissection of 27 cadavers, the authors detected a retroesophageal right subclavian artery in old man arising from distal aortic arch, crossed ventrally by left recurrent laryngeal nerve and dorsally by thoracic duct. On the right side, the aberrant subclavian artery was associated with nonrecurrent laryngeal nerve crossing a large tortuous inferior thyroid artery at multiple intersection points. Importantly, the nonrecurrent laryngeal nerve gave rise to extra laryngeal branch passing over Zuckerkandl’s tubercle of thyroid gland before its termination into the larynx. The relationships of the aberrant subclavian artery in the present case to thoracic duct, recurrent and nonrecurrent laryngeal nerves may have clinical relevance to various operations such as thyroidectomy, esophagectomy and surgical correction of the aberrant vessel. Therefore, these relationships should be well known by surgeons for prevention of iatrogenic damage of essential neurovascular structures during various surgeries.展开更多
目的探讨腔镜下甲状腺次全切术与常规开放手术治疗甲状腺功能亢进的疗效及对甲状旁腺功能的影响。方法选取2017年7月至2019年3月该院收治的甲状腺功能亢进患者102例,随机分为腔镜组和对照组,每组51例。腔镜组采用胸乳入路腔镜下改良甲...目的探讨腔镜下甲状腺次全切术与常规开放手术治疗甲状腺功能亢进的疗效及对甲状旁腺功能的影响。方法选取2017年7月至2019年3月该院收治的甲状腺功能亢进患者102例,随机分为腔镜组和对照组,每组51例。腔镜组采用胸乳入路腔镜下改良甲状腺次全切术,对照组采用常规术式。比较两组患者手术时间、术中出血量、术后引流量、术后住院时间,甲状腺功能和甲状旁腺功能,术后发生暂时性低钙血症、暂时性甲状旁腺功能减退情况,记录发生气管/食道损伤、高碳酸血症、呼吸性酸中毒、纵隔气肿及皮下血肿所致的呼吸困难、甲亢危象及死亡情况。结果腔镜组手术时间多于对照组,术中出血量、术后引流量、术后住院时间少于对照组,差异有统计学意义(P<0.05)。与术前比较,两组患者术后1个月、3个月血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平明显降低,促甲状腺激素(TSH)水平明显升高(P<0.05),术前、术后1个月、术后3个月两组患者TSH、FT3、FT4水平比较无明显差异(P>0.05)。两组患者术前Ca2+、甲状旁腺激素(PTH)水平比较无明显差异(P>0.05),术后1 d两组患者Ca2+、PTH水平明显降低,之后逐渐升高;术后1、3、7 d腔镜组Ca2+、PTH水平高于对照组(P<0.05),且腔镜组术后7 d Ca2+水平与术前相比,差异无统计学意义(P>0.05)。两组患者均未发生食管/气道损伤,且腔镜组未发生高碳酸血症、呼吸性酸中毒、纵隔气肿、皮下血肿所致呼吸困难及死亡情况;腔镜组术后暂时性低钙血症、暂时性甲状旁腺功能减退及喉返神经损伤发生率低于对照组,差异有统计学意义(P<0.05)。结论腔镜下甲状腺次全切术利用放大功能和神经监测在降低术后甲状旁腺功能减退和喉返神经损伤方面具有一定积极作用。展开更多
文摘The retroesophageal right subclavian artery may be associated with multiple neurovascular variations, which may impact various cervicothoracic surgeries. During the dissection of 27 cadavers, the authors detected a retroesophageal right subclavian artery in old man arising from distal aortic arch, crossed ventrally by left recurrent laryngeal nerve and dorsally by thoracic duct. On the right side, the aberrant subclavian artery was associated with nonrecurrent laryngeal nerve crossing a large tortuous inferior thyroid artery at multiple intersection points. Importantly, the nonrecurrent laryngeal nerve gave rise to extra laryngeal branch passing over Zuckerkandl’s tubercle of thyroid gland before its termination into the larynx. The relationships of the aberrant subclavian artery in the present case to thoracic duct, recurrent and nonrecurrent laryngeal nerves may have clinical relevance to various operations such as thyroidectomy, esophagectomy and surgical correction of the aberrant vessel. Therefore, these relationships should be well known by surgeons for prevention of iatrogenic damage of essential neurovascular structures during various surgeries.
文摘目的探讨腔镜下甲状腺次全切术与常规开放手术治疗甲状腺功能亢进的疗效及对甲状旁腺功能的影响。方法选取2017年7月至2019年3月该院收治的甲状腺功能亢进患者102例,随机分为腔镜组和对照组,每组51例。腔镜组采用胸乳入路腔镜下改良甲状腺次全切术,对照组采用常规术式。比较两组患者手术时间、术中出血量、术后引流量、术后住院时间,甲状腺功能和甲状旁腺功能,术后发生暂时性低钙血症、暂时性甲状旁腺功能减退情况,记录发生气管/食道损伤、高碳酸血症、呼吸性酸中毒、纵隔气肿及皮下血肿所致的呼吸困难、甲亢危象及死亡情况。结果腔镜组手术时间多于对照组,术中出血量、术后引流量、术后住院时间少于对照组,差异有统计学意义(P<0.05)。与术前比较,两组患者术后1个月、3个月血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平明显降低,促甲状腺激素(TSH)水平明显升高(P<0.05),术前、术后1个月、术后3个月两组患者TSH、FT3、FT4水平比较无明显差异(P>0.05)。两组患者术前Ca2+、甲状旁腺激素(PTH)水平比较无明显差异(P>0.05),术后1 d两组患者Ca2+、PTH水平明显降低,之后逐渐升高;术后1、3、7 d腔镜组Ca2+、PTH水平高于对照组(P<0.05),且腔镜组术后7 d Ca2+水平与术前相比,差异无统计学意义(P>0.05)。两组患者均未发生食管/气道损伤,且腔镜组未发生高碳酸血症、呼吸性酸中毒、纵隔气肿、皮下血肿所致呼吸困难及死亡情况;腔镜组术后暂时性低钙血症、暂时性甲状旁腺功能减退及喉返神经损伤发生率低于对照组,差异有统计学意义(P<0.05)。结论腔镜下甲状腺次全切术利用放大功能和神经监测在降低术后甲状旁腺功能减退和喉返神经损伤方面具有一定积极作用。
