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◆要旨:内視鏡補助下甲状腺手術(以下,VANS)は整容性に優れた術式であり,主として甲状腺良性腫瘍に対して施行されている.甲状腺手術において反回神経,上喉頭神経の走行を意識しながら手術を行うことは大変重要であり,これをおろそかにすると術後の声の変化や異常をきたし,患者のQOLに重大な影響を与えることになる.今回,筆者らは術前検査で鎖骨下動脈起始異常(以下,ASCA)を指摘された患者に対する甲状腺手術を経験した.この奇形を有する患者には反回神経が存在せず,非反回下喉頭神経(以下,NRILN)の存在と走行が問題となる.筆者らは術前の画像検査所見をもとに,NRILNの存在を意識しながらVANSを施行し得た1例を経験した.内視鏡による拡大された視野で,脈管や神経などの走行を詳細に観察,確認しながら手術を施行できるというVANSの特徴を生かして,合併症を起こすことなく手術を施行できた.同様の報告例は過去に1例もなく,示唆に富む手術症例であると考えられた.
Video-assisted neck surgery(VANS)is a surgical procedure that is cosmetically excellent, and is used mainly for benign tumors of thyroid gland. In performing VANS, it is very important to pay attention to the existence of the recurrent laryngeal nerve and superior laryngeal nerve, as in conventional surgical procedures. If careful attention is not paid, changes and abnormalities of the voice might develop postoperatively, causing serious influence on the patient's quality of life. We performed neck surgery in a patient who was found to have an aberrant subclavian artery(ASCA)preoperatively. In patients who have this anomaly, the recurrent laryngeal nerve does not exist, and the existence and course of the non-recurrent inferior laryngeal nerve(NRILN)become a problem. We performed VANS on the basis of the preoperative imaging findings, taking into consideration the existence of the NRILN. VANS is advantageousbecause it enables us to get a magnified visual field and to confirm the anatomy of the important blood vessels and nerves more easily. In the present case, VANS could be performed without any complications. No similar cases have been reported in the past, and we consider our present operated patient as a thought-provoking case.
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