CAJ | 학술논문

目的观测WSM-I型建腔器所成腔室的空间形态特征.方法 2010年1月至8月在我院接受改良Miccoli模式内镜甲状腺手术40例.入路制备完成后,统一采用建腔器建腔.手术包括一侧腺叶及峡部切除13例,腺叶部分切除27例.于建腔操作中运用空间测量针测量建腔器所成腔室的长、宽、高度等参数.结果①腔室底面的基本长度为(4.35±0.39)cm;中心基本宽度为(4.66±0.53)cm;中心基本高度为(1.36.4-0.34)cm;中心最大高度为(1.66±0.32)cm;周边基本高度为(0.98±0.29)cm;周边最大高度为(1.33±0.14)cm.②腔室体积与肿块大小呈负相关.③在手提吊钩感觉明显阻力时,借助垂直向微调,还可将腔室中心高度提升0.3 cm(22.1%).④在周边基本高度基础上,借钩端三维定向调节,可将该方位上的腔室周边高度增加0.35 cm(35.7%).结论建腔器所成腔室为一以钩端为脊顶的不规则形低矮类梯台状空间.此空间不仅非常稳定,且可灵活变形.后者可能是机械牵张法建腔的一个关键技术进步:总空间不变,通过三维调节,使有限空间得到最充分利用.
목적 관측WSM-I형건강기소성강실적공간형태특정.방법 2010년1월지8월재아원접수개량Miccoli모식내경갑상선수술40례.입로제비완성후,통일채용건강기건강.수술포괄일측선협급협부절제13례,선협부분절제27례.우건강조작중운용공간측량침측량건강기소성강실적장、관、고도등삼수.결과①강실저면적기본장도위(4.35±0.39)cm;중심기본관도위(4.66±0.53)cm;중심기본고도위(1.36.4-0.34)cm;중심최대고도위(1.66±0.32)cm;주변기본고도위(0.98±0.29)cm;주변최대고도위(1.33±0.14)cm.②강실체적여종괴대소정부상관.③재수제조구감각명현조력시,차조수직향미조,환가장강실중심고도제승0.3 cm(22.1%).④재주변기본고도기출상,차구단삼유정향조절,가장해방위상적강실주변고도증가0.35 cm(35.7%).결론 건강기소성강실위일이구단위척정적불규칙형저왜류제태상공간.차공간불부비상은정,차가령활변형.후자가능시궤계견장법건강적일개관건기술진보:총공간불변,통과삼유조절,사유한공간득도최충분이용.
Objective To comprehend spatial characteristics of the cavity created by a working space market.Methods 40 patients were successively operated according to the surgJical mode of minimally invasive video-assisted thyroidectomy from Jan.2010 to Aug.2010.Instead of hand-retraction.a mechanical arm-working space marker type I(WSM-I(R)，MIEO Medinstr Co.Ltd，China)，was applied to establish a working space.After the pathway making，a cavity above the gland was created and adjusted properly by the space maker，and then，endoscopic view was built and manipulation in the cavity was progressed throughout the later process.Geometric measurement of the cavity were performed at a"basic space position"just after the initial cavitation，and parameters such as length，width and height of the cavity were measured with a specifically scale-marked puncture needle(MC1820，Bard4(R)Max·Cor(R)Instrument)through mini-holes lay in the lifting hook(φ4mm，middle point and distant point).Results 13 cases received a lobectomy and isthmectomy.The other 27 cases received a partial thyroidectomy.Dimensional parameters were calculated as below.①The basic length of cavity button was(4.35±0.39)cm.The basic width of cavity button(distance at central point)was(4.66±0.53)cm.The basic central height of cavity was( 1.36±0.34)cm.The maximal central height archived by readjusting was(1.66±0.32)cm and a height increase of0.3 cm can be achieved(22.1％).②The basic peripheral height was(0.98±0.29)cm.The maximal peripheral height archived by readjusting directionally was(1.33±0.14)cm and a height increase of 0.35 cm can be achieved(35.7％).③Statistic analysis yielded a negative correlation between the cavity volume and the size of the nodule.Conclusions The working space created by WSM-I appears to be an laigh and irregular trapezoid stock with oblique roof formed by lifting hook.Although vertical height，especially the peripheral height，is a major restrictive dimension，the cavity can still be usable and enough for factual observation and manipulation，due to"compensating effect"of endoscope，finite space requirement of harmonica and"directional volume shifting"of WSM.