The Applied Anatomic Investigation, The Imaging Survey And The Clinic Significance Of Thyroid Surgery

Objective: Research the normal anatomy of the thyroid surgery to provide the anatomic foundation and precise data for the operation of thyroid disease with cadaver dissection and CT scanning.Methods and materials : Prepared 20 adult cadaver specimens fixed by formal, there was no surgical trauma in cervical part. The skin of neck was no defects. Eliminated these cervical part, which had thyroid history,deformation in appearance, and breakage. Dissected and measured these pecimens in orthophoria by these tools: sliding caliper (degree of accuracy was 0.02mm), doctor knife, blood vessel forceps tissue clipper, tissue forceps, shears, ruler, triangle ruler, conimeter, compasses. To survey the volume of thyroid, including height, thickness , width of left lobe of the thyroid gland, right lobe of thyroid gland and thyroid isthmic portion; The origin of superior thyroid artery includes angle between superior thyroid artery and the origin's artery; The starting height and diameter of starting part of superior thyroid artery; The length between superior thyroid artery and gland separated branch spot; The length between superior thyroid artery and superior laryngeal artery separated spot; The length of superior laryngeal artery; The length between gland separated branch spot of superior thyroid artery and upper pole of thyroid gland; The diameter of starting part of superior thyroid artery and its separated branch (the bole of superior thyroid artery,inferior branch of hyoid bone,superior laryngeal artery, sternoclei- domastoid branch,cricothyroid branches ,anterior branch of thyroid gland, posterior branch of thyroid gland); The origin and diameter of starting part of superior laryngeal nerve; The length of bole of superior laryngeal nerve; The diameter of starting part, ourser, distribution of internal and external branch of superior laryngeal nerve; The origin, length, diameter of starting part of inferior thyroid artery; The courser of recurrent laryngeal nerve above jugular vein incisure; The diameter of recurrent laryngeal nerve near cervical part; Thebranch of recurrent laryngeal nerve; The incidence of optima inferior thyroid artery; The position relation between external branch of superior laryngeal nerve and superior thyroid artery; The position relation between internal branch of superior laryngeal nerve and superior laryngeal artery; The position relation recurrent laryngeal nerve and inferior thyroid artery; The length between nyxis spot of femoral artery and the starting part of superior thyroid artery, inferior thyroid artery.There were 20 adults which received CT plain scan and fortified scanning in cervical part in the radioactive ray division of the third clinic hospital of Jilin university from March to December 2006. Eliminated thyropathy affection and cervical part cervical part, then carry out thyropathy CT surveying in thyropathy: Surveying volume of thyroid; Surveying surrounding issues and spaces of thyroid gland in CT; Displaying blood vessel of thyroid gland surgery in CTA. Results: (1) The height, thickness, width of left lobe of thyroid gland in anatomy: 49.52±1.10mm, 18.61±6.78 mm, 17.82±1.54 mm, the height, thickness, width of right lobe of thyroid gland in anatomy: 52.48±2.00 mm, 21.01±5.36 mm, 20.06±1.60 mm; The height, thickness, width of thyroid isthmic portion in anatomy: 15.57±0.94 mm, 21.73±1.25 mm, 4.65±0.52 mm. the height, thickness, width of left lobe of thyroid gland in CT: 48.56±3.22 mm, 18.07±8.20 mm, 18.15±5.53 mm; The height, thickness ,width of right lobe of thyroid gland in CT: 51.35±5.04 mm, 19.76±7.45 mm, 20.23±4.15 mm; The height, thickness, width of thyroid isthmic portion in CT: 14.92±3.35 mm, 21.16±5.11 mm, 4.42±1.57 mm. (2) The quantity of superior thyroid artery which start the starting of the part of external carotid artery was 31(77.5%), and start the branch part of common carotid artery was 7(17.5%), and start the common carotid artery was 2(5%). The starting height of superior thyroid artery: There were 37 sides which located between thyroid cartilage and cornu majus ossis hyoidei (92.5%), there were 3 sides which start the level of angle of mandible(7.5%). Included angle between superior thyroid artery and the origin'sartery was 37.20°±27.63°. The diameter of the starting part of superior thyroid artery was 2.35±0.78mm. (3) The length between superior thyroid artery and gland separated branch spot was 29.04±9.12mm; The length between superior thyroid artery and superior laryngeal artery separated spot was 9.85±4.41mm; The length of superior laryngeal artery was 19.83±5.22mm; The length between gland separated branch spot of left ,right superior thyroid artery and upper pole of thyroid gland was 16.31±9.78mm,9.55±4.11mm. (4) The diameters of starting part of bole of superior thyroid artery, inferior branch of hyoid bone,superior laryngeal artery, sternocleidomastoid branch, branches cricothyroid ,anterior branch of thyroid gland,posterior branch of thyroid gland were 2.35±0. 78mm, 0.85±0.15mm, 1.76±0.33mm, 1.12±0.20mm, 1.19±0.15mm, 1.32±0.35mm, 1.21±0.40mm. (5)The diameter of starting part of superior laryngeal nerve was 1.98±0.42mm; The bole length of superior laryngeal nerve was 16.21±7.14mm; The diameters of starting part of internal and external branch of superior laryngeal nerve were 1.72±0.35mm, 1.46±0.51mm. (6) Inferior thyroid artery from thyrocervical trunk were 34 sides(85%), diameter of starting part of inferior thyroid artery was 2.61±0.12mm; From subclavian artery were 4 sides(10%), diameter of starting part of inferior thyroid artery was 2.56±0.35mm; From common carotid artery was 1 side(2.5%), diameter of starting part of inferior thyroid artery was 2.50mm; From aortic arch was 1 side (2.5%), the diameter of starting part of inferior thyroid artery was 2.67mm. The lengh of the starting of the inferior thyroid artery to the turning was 17.21±4.12mm, the lengh of the turning of inferior thyroid artery to the gland to where the artery was 12.35±3.27mm, the included angle between the inferior thyroid artery and the starting artery was 113.7°±22.5°, the turning angle of inferior thyroid artery was 51.2°±17.6°,the crossing angle between the inferior thyroid artery and laryngeal nerve was 95.1°±21.5°. (7) The diameter of recurrent laryngeal nerve near cervical part was 2.10±0.51mm; The branching types of recurrent laryngealnerve: typeⅡ6 sides(15%), typeⅢ21 sides(52.5%), typeⅣ10sides(25%), typeⅤ3sides(7.5%). (8) The incidence of optima inferior thyroid artery was 3 sides(7.5%),from aortic arch was 2 sides, from brachiocephalic trunk was1 side. (9) The position relation between external branch of superior laryngeal nerve and superior thyroid artery were typeⅠ21 sides(52.5%), typeⅡ15 sides(37.5%), typeⅢ4 sides(10%); The position relation between internal branch of superior laryngeal nerve and superior laryngeal artery: typeⅠ18 sides(45%), typeⅡ15 sides(37.5%), typeⅢ7 sides; (17.5%); the position relation recurrent laryngeal nerve and inferior thyroid artery were type A 15 sides (37.5%), type B 3 sides (7.5%), type C 22 sides(55%). (10) The length between nyxis spot of right femoral artery and starting part of left superior thyroid artery, inferior thyroid artery were 61.74±12.37mm, 51.53±9.62mm; The length between nyxis spot of right femoral artery and starting part of right superior thyroid artery, inferior thyroid artery were 63.05±10.24mm, 52.36±12.15mm. (11) CT can clearly disply prevertebral spaces, internal organs spaces, carotid artery spaces. CTA can clearly disply inferior thyroid artery from thyrocervical trunk were 36 sides (90%), from subclavian artery were 3 sides (7.5%), from aortic arch was 1 side (2.5%); Superior thyroid artery from starting part of external carotid artery were 32sides(80%), from branch part of common carotid artery were 7 sides (17.5%), from common carotid artery were 1 sides (2.5%).Conclusion: The common forms of thyroid included were left lobe, right lobe, isthmic portion. The quantity of thyroid artery was 4 branchs in most conditions, but the quantity of thyroid artery was 5 branchs in less conditions. The branch quantity of thyroid artery was various. The branch quantity of superior laryngeal nerve and recurrent laryngeal nerve were uncertain. The relation about position between superior laryngeal nerve, recurrent laryngeal nerve and superior, inferior thyroid artery were complex. Included angle between thyroid artery and the origin's artery provides the morphology foundation for thyroid interventional therapy. CT scanning can clearly displayarchitectonic and the gap of thyroid surgery . CTA can also volumetric display the courser of thyroid feeding artery. Hence, CTA can provide scheme before operation of thyroid disease and evaluation after the operation of thyroid for the thyroid field of operation.