The information presented in the literature on the use of minimally invasive interventions in the treatment of hyperparathyroidism is not fully justified by topographical and anatomical studies and does not take into account individual features of the location and syntopia of the parathyroid glands, which requires additional scientific research. Purpose of the study: based on the topographical and anatomical features of the structure of the anterior neck region, determine the most rational methods of minimally invasive interventions on the parathyroid glands, evaluate their clinical effectiveness and justify their use in the implementation of a treatment and diagnostic algorithm in patients with hyperparathyroidism. Material and methods: The design of the study consisted of two stages – anatomical and clinical. Anatomical stage is performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross-cuts of the neck (n=3) of human cadavers. During the clinical stage, the results of examination and treatment of 53 patients with hyperparathyroidism, who underwent surgery using three methods: Сonventional (n=18/34%); Minimally Invasive Video Assisted Parathyroidectomy (n=32/60%) and Transoral Endoscopic Parathyroidectomy Vestibular Approach (n=3/6%). Results: at the anatomical stage, the validity and safety of minimally invasive video-assisted Parathyroidectomy was proved. The use of this access in clinical practice as an alternative to the traditional one has shown its effectiveness in reducing the frequency of specific postoperative complications from 16.7% to 6.3% with an acceptable increase in the duration of surgery from 42.8±15.7 to 64.4±23.5 minutes and maintaining the average duration of inpatient treatment after surgery at the level of 3.4±0.6 days. Conclusion: minimally invasive video-assisted parathyroidectomy can be considered the operation of choice in the treatment of patients with hyperparathyroidism. The use of this technique with the implementation of lateralization of the thyroid lobe, the preservation of the upper and lower thyroid vessels, as well as the use of intraoperative neuromonitoring and Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid can improve the results of surgical treatment, reduce the number of postoperative complications, the frequency of persistence and relapse of the disease, and improve the quality of life of patients.
Introduction. The information presented in the literature on the use of minimally invasive interventions in the treatment of hyperparathyroidism is not fully justified by topographical and anatomical studies and does not take into account individual features of the location and syntopia of the parathyroid glands, which requires additional scientific research.Objective.Based on the topographical and anatomical features of the structure of the anterior neck region, we determined the most rational methods of minimally invasive interventions on the parathyroid glands and evaluated their clinical effectiveness in patients with hyperparathyroidism.Methods and materials. The design of the study consisted of two stages – topographical and anatomical, and clinical. Topographical and anatomical stage was performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross sections of the neck (n=44) of human cadavers. During the clinical stage, we studied results of examination and treatment of 53 patients with hyperparathyroidism, who underwent surgery using three methods: Сonventional (n=18/34 %); Minimally Invasive Video-Assisted Parathyroidectomy (n=32/60 %) and Transoral Endoscopic Parathyroidectomy Vestibular Approach (n=3/6 %).Results. During the topographical and anatomical stage, the validity and safety of minimally invasive video-assisted parathyroidectomy was proved. The use of this access in clinical practice as an alternative to the conventional one has shown its effectiveness in reducing the frequency of specific postoperative complications from 16.7 to 6.3 % with an acceptable increase in the duration of surgery from (42.8±15.7) to (64.4±23.5) minutes and maintaining the average duration of inpatient treatment after surgery at the level of (3.4±0.6) days.Conclusion. Minimally invasive video-assisted parathyroidectomy can be considered the operation of choice in the treatment of patients with hyperparathyroidism. The use of this technique with the implementation of lateralization of the thyroid lobe, the preservation of the superior and inferior thyroid vessels, as well as the use of intraoperative neuromonitoring and identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid can improve the results of surgical treatment, reduce the number of postoperative complications, the frequency of persistence and relapse of the disease, and improve the quality of life of patients.
Цель. Разработать новые подходы к оценке хирургической анатомии околощитовидных желез и на основе этого получить новые данные, позволяющие повысить качество планирования и проведения операций на органах шеи, уменьшить вероятность возникновения диагностических ошибок и развития интраоперационных и послеоперационных осложнений.Материал и методы. Исследование выполнено на 152 трупах мужчин (средний возраст -47,0±1,0 год) и 68 трупах женщин (51,3±1,9 лет). Перед вскрытием каждого трупа производилось измерение антропометрических показателей шеи. На извлеченных из трупа органокомплексах шеи измерялись: ширина, длина оси, толщина и высота околощитовидных желез. Были предложены и определены параметры, характеризующие положение околощитовидных желез по отношению к щитовидной железе в разных плоскостях.Результаты. Всего визуализировано 1033 околощитовидные железы. Более чем в половине наблюдений (54,0%) число желез превысило 4. Длина оси околощитовидных желез в 10,5% наблюдений оказалась больше 10 мм. Анализ возрастных изменений линейных размеров и объема желез позволил выделить в постнатальном периоде онтогенеза желез три основных периода. Установлено, что 95,4% изученных желез имели типичную локализацию по отношению к высоте долей щитовидной железы. Наиболее удаленными от срединной линии оказались железы, расположенные выше верхнего полюса доли щитовидной железы, а наиболее приближенными -железы, локализующиеся ниже нижнего полюса щитовидной железы. Угол наклона оси околощитовидных желез к срединной линии во фронтальной плоскости и удаление желез от задней поверхности доли щитовидной железы зависит от уровня расположения околощитовидных желез по отношению к высоте доли щитовидной железы.Заключение. Внедрение предложенных критериев в практику позволит выполнять предоперационное прогнозирование топографии околощитовидных желез и их тщательную интраоперационную визуализацию, повышая качество выполнения операций на щитовидной и околощитовидных железах.Ключевые слова: околощитовидные железы, щитовидная железа, хирургическая анатомия, топография, линейные размеры, интраоперационная визуализация, послеоперационные осложнения Objectives. To develop new approaches to the assessment of surgical anatomy of the parathyroid glands and to obtain new data permitted to improve the quality of planning and performance of operations on the organs of the neck, to reduce the risk of diagnostic errors and development of intraoperative and postoperative complications.Methods. The study was performed on cadavers (152 men; average age -47,0±1,0 years) and (68 women; 51,3±1,9 years). Before the autopsy of each cadaver the anthropometric measurements of the neck were done. The width, length of the axis, thickness and height of the parathyroid glands had been measured on the neck organocomplexes extracted from the corpses. The parameters characterized the position of the parathyroid glands towards to the thyroid gland in different planes were proposed.Results. Totally 1033 parathyroid glands were visualized. More than half of the cases (54,0%) the ...
ФГБОУ ВО «Воронежский государственный медицинский университет им. Н.Н. Бурденко», Российская ФедерацияЦель. Разработать способ прогнозирования количества межреберных нервов у латерального края апо-невротического влагалища прямой мышцы живота в околопупочной области передней брюшной стенки.Материал и методы. Исследовано 88 нефиксированных трупов лиц обоего пола без признаков па-тологии передней брюшной стенки: 45% трупов лиц мужского пола (средний возраст -53,8±11,9 года) и 55% -женского пола (51,9±13,2 года). Измерялись linea bicostalis (расстояние между нижними точками реберных дуг) и linea bispinalis (расстояние между передними верхними остями подвздошных костей). Определялось количество межреберных нервов в области латерального края апоневротического влагалища прямой мышцы живота на протяжении околопупочной области передней брюшной стенки.Результаты. Linea bicostalis в среднем составила 29,2±0,3 см, а linea bispinalis -28,2±0,2 см. В об-ласти латерального края апоневротического влагалища прямой мышцы живота на протяжении околопу-почной области передней брюшной стенки чаще всего наблюдалось 2 пары межреберных нервов (60% наблюдений), несколько реже -1 пара нервов (20%). В 11% к прямой мышце живота подходило 3 пары межреберных нервов, а в 2% случаев встретилось 4 пары нервов. В 7% отмечалось асимметричное количе-ство межреберных нервов. С использованием метода логистической регрессии был предложен способ про-гнозирования вероятности обнаружения 2 пар межреберных нервов в области латерального края апоневро-тического влагалища прямой мышцы живота на протяжении околопупочной области передней брюшной стенки: P(%)=100×(1/(1+e^(12,1+0,33×a1-0,76×a2))), где P -вероятность обнаружения 2 пар межреберных нервов, a1 -linea bispinalis, a2 -linea bicostalis.Заключение. Разработанный способ позволяет прогнозировать количество межреберных нервов у ла-терального края апоневротического влагалища прямой мышцы живота в околопупочной области передней брюшной стенки и может быть рекомендован для применения в клинической практике. Ключевые слова: передняя брюшная стенка, апоневротическое влагалище, прямая мышца, иннервация, межреберные нервы, пупочная грыжа, герниопластикаObjectives. To develop a method of prognostication of the number of intercostal nerves in the lateral edge of the aponeurotic sheath of the rectus abdominis muscle in the umbilical region of the anterior abdominal wall.Methods. The unfixed corpses (n= 88) of both sexes without pathology of the anterior abdominal wall were studied: 45% of male corpses (average age -53,8±11,9 years) and 55% -females (51,9±13,2 years). Linea bicostalis (the distance between the lower points of the costal arches) and linea bispinalis (the distance between the front upper iliac spines) were measured. The number of the intercostal nerves at the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region of the anterior abdominal wall was established.Results. Linea bicostalis on the average composed 29,2±0,3 cm and the linea bispinalis -28,2±0,2 cm. In the ar...
New approaches to the assessment of clinical anatomy of the parathyroid glands were developed. The obtained new data allow improving the quality of planning and carrying out operations on the thyroid and parathyroid glands, to reduce the risk of errors in diagnosis and intra-operative and post-operative complications. 220 corpses and 82 patients after surgery on the thyroid gland pathology were examined. In morphological material 4 or 5 of the parathyroid glands were found. Size parathyroid glands was 0,70x0,43x0,30 cm, volume - 0,0531+0,0016 cm3, and the total volume of parathyroid tissue in one case - 0,1903±0,0075 cm3. Maximum size parathyroid glands without pathologies are: 1,4x1,0x1,0 cm. On the basis of the ratio of integral indexes forms parathyroid glands were determined. The authors identified three periods of the postnatal development of human parathyroid glands: maximum growth (up to 35 years), the relative stability (36-65 years), involution (over 65 years). The revealed regularities topography are different for the «upper» of the parathyroid glands(parathyroid glands IV), located in the zones 2-3, 3 and 3-4 and to «lower» glands (parathyroid glands III) at the level of 1, 1-2, 2, 4, 5 or 5 zones. Five common variants of parathyroid glands different sizes and shapes in relation to the thyroid gland were identified. It was established that studied nosologic forms of diseases of the thyroid doesn´t affect the linear size and topography of the parathyroid glands in the frontal plane. New data on the clinical anatomy of the parathyroid glands allow to reduce the cases of intra-and postoperative complications in operations at the front of the neck.
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