Dolidze David Dzhonovich,Долидзе Давид Джонович,Mumladze Robert Borisovich,Мумладзе Роберт Борисович,Melnik Kirill Viktorovich,Мельник Кирилл Викторович,Vardanyan Arshak Vardanovich,Варданян Аршак Вар
申请号：
RU2015148813
公开号：
RU0002616763C1
申请日:
2015.11.13
申请国别(地区):
RU
年份:
2017
代理人:
摘要：
FIELD: medicine.SUBSTANCE: extrafascial removal of thyroid and neck cellular tissue with lymph nodes is performed under endotracheal anesthesia in compliance with a certain intervention phasing. At that, for surgical access a smaller incision of 10-11 cm is applied starting from the point situated at a distance of 4 cm from mastoid extending along the lateral edge of the sternocleidomastoid muscle and spaced 2-3 cm from the sternoclavicular joint, smoothly passing into a horizontal part parallel to the skin folds and terminating at a point located at a distance of 3 cm from the jugular notch, going over the middle line of the neck by 1 cm with subcutaneous muscles separation with a skin-fat flap. Then the sterno-thyroid and sterno-sublingual, sternoclavicular-mastoid and omohyoid muscles are isolated and mobilized. Next, thyreoidectomy is performed using the extrafascial technique while fully removing the thyroid tissue, including the pyramid portion. At this stage, prevention of damage of the upper and recurrent laryngeal nerves is performed using neuromyography, to maintain parathyroid, "stress-test" is applied, which consists in a periodic light tapping of anatomical structures in the operational field by the surgical instrument, where browning or hyperemia with vascular injection identify parathyroid glands difference from fat lobules and lymph nodes, after thyroidectomy, visualization and preservation of parathyroid glands and recurrent laryngeal nerves, central lymphadenectomy is performed. Then the cellular tissue and lymph nodes of neck zones II-V are removed with preservation of great vessels of the neck, brachial plexus, superficial cervical plexus branches, additional and hypoglossal nerves. At the end of the operation sterno-thyroid and sternohyoid muscle are sustured longitudinally to cover the trachea, the latter is separated from the subcutaneous tissue, the neurovascular bundle is closed by sternocleidomastoid muscle medial edge suturing with sterno-
