臨床外科67巻13号

2012年12月発行

特集 本当は怖い 臓器解剖変異―外科医が必ず知っておくべき知識

甲状腺・副甲状腺手術で重要な解剖変異

著者： 鈴木眞一¹ 福島俊彦¹ 阿美弘文²

所属機関： ¹福島県立医科大学器官制御外科学講座 ²大原総合病院外科

ページ範囲：P.1484 - P.1489

文献概要

【ポイント】

◆甲状腺・副甲状腺手術の最大のリスクは反回神経損傷である．反回神経損傷の最大のリスクポイントは下甲状腺動脈幹より頭側の喉頭外にある約2cmの部分で，解剖学的変異も多いところである．

◆上喉頭神経外枝を温存するには甲状腺上極，喉頭と上甲状腺動静脈の3角形の部分で確認温存の注意をして甲状腺近傍で動静脈を切離する．

◆Zuckerkandlの結節は下甲状腺動脈とともに反回神経発見の目印である．

◆副甲状腺は位置の異常と数の異常がある．

参考文献

1）Skadalakis JE, Skandalakis PN, Skandalakis LJ：Surgical anatomy and technuique：a pocket manual, 2nd ed. NY, Springer, 1999, pp31-44

2）Karabay N, Comlekci A, Canda MS, et al：Thyroid hemiagenesis with multinodular goiter：a case report and review of the literature. Endocr J 50：409-413, 2003

3）Shabana W, Delange F, Freson M, et al：Prevalence of thyroid hemiagenesis：ultrasound screening in normal children. Eur J Pediatr 159：456-458, 2000

4）Gemsenjaeger E：Atlas of thyroid surgery, principles, practice, and clinical cases. NY, Thieme, 2009, pp9-12

5）Serpell JW：New operative surgical concept of two fascial layers enveloping the recurrent laryngeal nerve. Ann Surg Oncol 17：1628-1636, 2010

6）Yalçin B, Ozan H：Detailed investigation of the relationship between the inferior laryngeal nerve including laryngeal branches and ligament of Berry. J Am Coll Surg 202：291-296, 2006

7）Beldi G, Kinsbergen T, Schlumpf R：Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World J Surg 28：589-591, 2004

8）Snyder SK, Hendricks JC：Intraoperative neurophysiology testing of the recurrent laryngeal nerve：plaudits and pitfalls. Surgery 138：1183-1192, 2005

9）Yarbrough DE, Thompson GB, Kasperbauer JL, et al：Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 136：1107-1115, 2004

10）Chiang FY, Lee KW, Huang YF, et al：Risk of vocal palsy after thyroidectomy with identification of the recurrent laryngeal nerve. Kaohsiung J Med Sci 20：431-436, 2004

11）Harness JK, Fung L, Thompson NW, et al：Total thyroidectomy：complications and technique. World J Surg 10：781-786, 1986

12）Hermann M, Alk G, Roka R, et al：Laryngeal recurrent nerve injury in surgery for benign thyroid diseases：effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg 235：261-268, 2002

13）Chiang FY, Lu IC, Chen HC, et al：Anatomical variations of recurrent laryngeal nerve during thyroid surgery：how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci 26：575-583, 2010

14）Beneragama T, Serpell JW：Extralaryngeal bifurcation of the recurrent laryngeal nerve：a common variation. ANZ J Surg 76：928-931, 2006

15）Hisham AN, Lukman MR：Recurrent laryngeal nerve in thyroid surgery：a critical appraisal. ANZ J Surg 72：887-889, 2002

16）Shao T, Yang W, Zhang T, et al：A newly identified variation at the entry of the recurrent laryngeal nerve into the larynx. J Invest Surg 23：314-320, 2010

17）Yalçin B：Anatomic configurations of the recurrent laryngeal nerve and inferior thyroid artery. Surgery 139：181-187, 2006

18）Katz AD：Extralaryngeal division of the recurrent laryngeal nerve：report on 400 patients and the 721 nerves measured. Am J Surg 152：407-410, 1986

：Randolph GW eds：Surgery of the Thyroid and Parathyroid Glands, 1st ed. Philadelphia, Saunders, 2003, pp300-342

20）Page C, Monet P, Peltier J, et al：Non-recurrent laryngeal nerve related to thyroid surgery：report of three cases. J Laryngol Otol 122：757-761, 2008

21）Toniato A, Mazzarotto R, Piotto A, et al：Identification of the nonrecurrent laryngeal nerve during thyroid surgery：20-year experience. World J Surg 28：659-661, 2004

22）Tzinas S, Droulias C, Harlaftis N：Vascular patterns of the thyroid gland. Am Surg 42：639-644, 1976

23）Hurtado-Lopez LM, Pacheco-Alvarez MI, Montes-Castillo Mde L, et al：Importance of the intraoperative identification of the external branch of the superior laryngeal nerve during thyroidectomy：electromyographic evaluation. Thyroid 15：449-454, 2005

24）Loukas M, Louis RG Jr, Cruz GS：A case of an anomalous cricothyroid artery. Folia Morphol（Warsz）63：359-362, 2004

25）Shoja MM, Tubbs RS, Loukas M, et al：Emil Zuckerkandl（1849-1910）：anatomist and pathologist. Ann Anat 190：33-36, 2008

26）Pelizzo MR, Toniato A, Gemo G：Zuckerkandl's tuberculum：an arrow pointing to the recurrent laryngeal nerve（constant anatomical landmark）. J Am Coll Surg 187：333-336, 1998

27）Koçak S, Aydintuğ S：Zuckerkandl's tuberculum. J Am Coll Surg 190：98-99, 2000

28）Yalçin B, Poyrazoglu Y, Ozan H：Relationship between Zuckerkandl's tubercle and the inferior laryngeal nerve including the laryngeal branches. Surg Today 37：109-113, 2007

29）Lappas D, Noussios G, Anagnostis P, et al：Location, number and morphology of parathyroid glands：results from a large anatomical series. Anat Sci Int, 2012［Epub ahead of print］

30）Medrano C, Hazelrigg SR, Landereneau RJ, et al：Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg 69：221-223, 2000

31）Prinz RA, Gamtros OI, Allison DJ, et al：Reoperations for hyperparathyroidism. Surg Gynecol Obstet 152：760-764, 1981

32）Arnault V, Beaulieu A, Lifante JC, et al：Multicenter study of 19 aortopulmonary window parathyroid tumors：the challenge of embryologic origin. World J Surg 34：2211-2216, 2010

33）d'Alessandro AF, Montenegro FL, Brandão LG, et al：Supernumerary parathyroid glands in hyperparathyroidism associated with multiple endocrine neoplasia type 1. Rev Assoc Med Bras 58：323-327, 2012

34）Henry JF, Defechereux T, Raffaelli M, et al：Supernumerary ectopic hyperfunctioning parathyroid gland. Ann Chir 125：247-252, 2000