【摘要】：目的：通過對甲狀腺術(shù)中軟組織機械牽張法建腔的要素化分析,研制一種頸部手術(shù)用牽開器。方法：2013年1月至2013年8月,在我院科接受手術(shù)的甲狀腺腫瘤患者100例。術(shù)中通過程序化手術(shù)操作步驟,對腺葉切除,錐葉及喉前區(qū)、氣食管溝區(qū)、胸骨上窩區(qū)淋巴清掃中機械牽引組織深度及拉鉤手柄相對于術(shù)中頸部水平面的傾角測量。得出數(shù)據(jù)作為頸部手術(shù)牽開器的設(shè)計依據(jù),并提出設(shè)計的總體框架。結(jié)果：①100例手術(shù)患者的觀察及測量均順利完成。②頸部甲狀腺手術(shù)拉鉤的水平運動軌跡,是以甲狀腺為中心,拉鉤在頸部水平面呈類圓環(huán)形軌跡運動③甲狀腺手術(shù)中腺葉切除機械牽引軟組織深度分別為(上極4.13±0.08cm.中極3.55±0.03cm、下極3.55±0.04cm)；中央?yún)^(qū)頸淋巴清掃中機械牽引軟組織深度分別為(錐葉及喉前區(qū)3.49±0.07cm、氣食管溝區(qū)4.21±0.11cm、胸骨上窩區(qū)3.34±0.05cm)④甲狀腺手術(shù)中腺葉切除,拉鉤手柄相對于術(shù)中頸部水平面的傾角分別為(上極45.33±0.20°、中極21.11±0.84°、下極21.77±1.93°)；中央?yún)^(qū)頸淋巴清掃中機械牽引軟組織,拉鉤手柄相對于術(shù)中頸部水平面的傾角分別為(錐葉及喉前區(qū)73.58±1.80°、氣食管溝區(qū)23.27±1.45°、胸骨上窩區(qū)43.20±0.88°)。結(jié)論：①頸部甲狀腺常規(guī)手術(shù)基本操作為機械牽張法建腔。主要是以甲狀腺為中心,拉鉤在頸部水平面呈類圓環(huán)形軌跡運動,同時拉鉤手柄與頸部水平面呈不同傾角(0-75°)牽拉頸部軟組織形成操作空間。②通過術(shù)中機械牽張法建腔的要素化分析,能夠設(shè)計出一種手術(shù)用牽開器,并提出設(shè)計的基本架構(gòu)。以一個橢圓形水平軌道為支撐,通過連接器連接拉鉤(鉤端長度3-5cm)�？傮w結(jié)構(gòu)協(xié)同運作,維持對軟組織的機械牽引,實現(xiàn)手術(shù)操作。
[Abstract]:Objective: to develop a retractor for cervical surgery by analyzing the essential factors of soft tissue distraction during thyroid surgery. Methods: from January 2013 to August 2013, 100 patients with thyroid tumor underwent surgery in our hospital. The depth of the mechanical traction tissue and the inclination of the retractor handle relative to the horizontal plane of the neck were measured during the dissection of the gland lobectomy, the conical lobe and the anterior laryngeal area, the pneumoesophageal sulcus area and the suprasternal fossa area. The data can be used as the basis for the design of the retractor for neck surgery, and the overall frame of the design is put forward. Results the observation and measurement of 1 100 cases of operation successfully completed the horizontal movement track of the retractor in the neck thyroid surgery, which was centered on the thyroid gland. The retractor moves in the horizontal plane of the neck like a circular trajectory. 3 the depth of the soft tissue of mechanical traction after resection of the lobectomy was 4.13 鹵0.08cm in the upper pole of thyroidectomy. 3. 55 鹵0. 03 cm in the middle pole and 3. 55 鹵0.04cm in the lower pole. The depth of the soft tissue of mechanical traction was 3. 49 鹵0. 07 cm in the central area and 3. 49 鹵0. 07 cm in the anterior larynx area, 4. 21 鹵0. 11 cm in the gastroesophageal sulcus area and 3. 34 鹵0.05cm in the suprasternal fossa area respectively. The inclination of the retractor handle relative to the horizontal plane of the neck was 45.33 鹵0.20 擄in the upper pole, 21.11 鹵0.84 擄in the middle pole, 21.77 鹵1.93 擄in the lower pole. The inclination of the retractor handle relative to the horizontal plane of the neck was 73.58 鹵1.80 擄in the conical lobe and anterior larynx, 23.27 鹵1.45 擄in the gastroesophageal sulcus and 43.20 鹵0.88 擄in the suprasternal fossa. Conclusion the basic procedure of routine operation of neck thyroid gland is mechanical distraction. Mainly centered on the thyroid gland, the retractor moves like a circular trajectory on the horizontal plane of the neck. At the same time, the retractor handle has different inclination angle (0-75 擄) to pull the neck soft tissue formation operation space .2 through the analysis of the elements of the intraoperative mechanical stretch method to build the cavity, a kind of retractor can be designed, and the basic structure of the design can be put forward. Supported by an elliptical horizontal track, the hook is connected by a connector (hook length 3-5cm). The overall structure works together to maintain the mechanical traction of soft tissue and to realize the operation.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R653

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