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目的从应用解剖学的角度重新认识气管前筋膜及其周围间隙,为甲状腺癌手术提供解剖学依据。方法对福尔马林固定的尸体标本进行解剖以及术中甲状腺癌患者的气管前筋膜进行观察,观察气管前筋膜及气管前间隙的特点。结果气管前筋膜分为前后两层,两层筋膜之间是甲状腺峡部、脂肪、气管前淋巴结、甲状腺最下动脉、胸腺,甲状腺下静脉等。前层筋膜与舌骨下肌筋膜之间存在一间隙,为舌骨下肌后间隙;后层筋膜与气管之间存在一个无血管的间隙,为气管前间隙,该间隙向下通向纵膈,向上经甲状腺峡部后方通向喉前,向两侧延伸至气管食管沟。结论气管前筋膜分为前后两层,分离显露甲状腺及气管前脂肪淋巴组织时应该保持气管前筋膜前层的完整性;气管前间隙是处理峡部和气管前淋巴结的外科层面。
Objective To re-recognize the anterior tracheal fascia and its surrounding space from the perspective of anatomy and provide an anatomical basis for thyroid cancer surgery. Methods The autopsy specimens of formalin-fixed cadavers and the pre-tracheal fascia in patients with thyroid cancer were observed. The characteristics of the anterior tracheal fascia and the anterior tracheal space were observed. Results The anterior trachea fascia was divided into two layers. The two fascia were thyroid isthmus, fat, anterior bronchial lymph nodes, inferior thyroid artery, thymus, and thyroid vein. There is a gap between the anterior fascia and the hyoid muscle fascia, which is the posterior hyoid muscle space; there is an avascular gap between the posterior fascia and the trachea, which is the anterior tracheal gap that passes downwards To the mediastinum up through the posterior thyroid isthmus leading to the larynx, to both sides of the trachea esophageal groove. Conclusion The anterior tracheal fascia is divided into two layers. The separation of the thyroid and the anterior tracheal adipose tissue should maintain the integrity of the anterior tracheal fascia. The anterior tracheal space is the surgical layer for treating isthmus and anterior tracheal lymph nodes.