CN209951310U - Secondary-trauma-preventing special retractor for cystoscope thyroid - Google Patents
Secondary-trauma-preventing special retractor for cystoscope thyroidDownload PDFInfo
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Abstract
Translated fromChinese
Description
Translated fromChinese技术领域technical field
本实用新型属于医疗器械技术领域，具体涉及一种防二次创伤型腔镜甲状腺专用拉钩。The utility model belongs to the technical field of medical devices, and in particular relates to a special retractor for the thyroid gland of an anti-secondary trauma type endoscope.
背景技术Background technique
近年来，在甲状腺疾病的外科治疗领域中，腔镜甲状腺手术因其切口小而隐蔽、术后颈部没有切口瘢痕等优点，在国内外逐渐应用于临床。在常规开放甲状腺手术中，手术野的显露非常关键，为此，必须将位于甲状腺前方的颈前肌群，以便尽可能的暴露病灶，方便窥镜探视。但在腔镜手术中，若使用腔镜手术钳牵引颈前肌群则需要增加更多的腔镜手术切口，并且在操作过程中器械会遮挡部分腔镜视野，影响术者操作。后来有用丝线牵引肌群的操作方式，然而又存在显露效果有限且无法移动牵拉位置的缺点。基于上述原因，非常有必要使用一种能够在微创的前提下，安全、可靠、灵活地牵引颈前肌群，并提供良好的腔镜甲状腺手术视野的拉钩结构。有鉴于此，中国专利公告号为“CN 202489985 U”的实用新型名称为“腔镜用甲状腺拉钩”以及中国专利公告号为“CN 206518571 U”的实用新型名称为“一种腔镜甲状腺手术拉钩”中都相应提供了一种拉钩结构，其主体都包括钩头及拉钩连接杆，问题在于：其一，在进行腔镜甲状腺手术时，不可避免存在出血等问题，大量血液淤积于术点区域，对术野干扰极大，从而给实际手术操作带来诸多困扰。其二，在进行拉钩牵拉肌群操作之前，是需要首先对甲状腺部位的颈前皮肤甚至是肌肉实行穿刺或切割操作的，以便留出供钩头穿入的孔洞或刀口。然而，上述孔洞或刀口或需要直接额外以手术刀等辅助器械实现，或又如上述文献所述的直接使用尖锐顶端来穿刺实现。采用手术刀等辅助器械会导致额外的手术准备时间，影响手术时长，同时刀口深度难以掌控。而采用自带尖锐顶端的拉钩，显然仅考虑到术前穿刺而没考虑到术时使用。在拉钩完全进入患者皮肤下并牵拉甲状腺前方的颈前肌群时，尖锐的拉钩顶端往往会再次刺破颈前肌群甚至是血管组织，造成二次创伤，严重时甚至可引发大出血状况。In recent years, in the field of surgical treatment of thyroid diseases, endoscopic thyroid surgery has been gradually used in clinical practice at home and abroad due to its advantages of small incision and concealment, and no incision scar in the neck after operation. In conventional open thyroid surgery, the exposure of the surgical field is very critical. For this reason, the anterior cervical muscle group located in front of the thyroid must be exposed to expose the lesion as much as possible and facilitate endoscopic observation. However, in endoscopic surgery, more endoscopic surgical incisions need to be added if endoscopic surgical forceps are used to distract the anterior cervical muscles, and the instrument will block part of the endoscopic field of view during the operation, affecting the operator's operation. Later, the operation method of using silk thread to stretch the muscle group has the disadvantages of limited exposure and inability to move the pulling position. Based on the above reasons, it is very necessary to use a retractor structure that can safely, reliably and flexibly retract the anterior cervical muscles and provide a good field of view for endoscopic thyroid surgery under the premise of minimally invasive surgery. In view of this, the utility model name of the Chinese Patent Announcement No. "CN 202489985 U" is "Endoscopic Thyroid Retractor" and the utility model name of the Chinese Patent Announcement No. "CN 206518571 U" is "A Retractor for Endoscopic Thyroid Surgery. "China Capital Corporation provides a retractor structure, the main body of which includes a hook head and a retractor connecting rod. The problems are: First, when performing endoscopic thyroid surgery, there are inevitable problems such as bleeding, and a large amount of blood accumulates in the operation site area. , which greatly interferes with the surgical field, which brings a lot of trouble to the actual surgical operation. Second, before the operation of pulling the muscle group with the retractor, it is necessary to puncture or cut the skin or even the muscle in front of the neck in the thyroid part, so as to leave a hole or an incision for the hook head to penetrate. However, the above-mentioned holes or incisions may need to be directly realized with an auxiliary instrument such as a scalpel, or directly used for puncturing with a sharp tip as described in the above-mentioned documents. The use of auxiliary instruments such as scalpels will lead to additional operation preparation time, affecting the operation time, and it is difficult to control the depth of the incision. The use of the retractor with its own sharp tip obviously only considers the preoperative puncture and does not consider the use during the operation. When the retractor completely enters under the patient's skin and pulls the anterior cervical muscle group in front of the thyroid, the sharp tip of the retractor often punctures the anterior cervical muscle group or even the vascular tissue again, causing secondary trauma and even severe bleeding.
发明内容SUMMARY OF THE INVENTION
本实用新型的目的是克服上述现有技术的不足，提供一种结构合理而实用的防二次创伤型腔镜甲状腺专用拉钩，其在能达到充分暴露甲状腺病灶的同时，有效避免术时二次创伤状况的发生，并同步具备腔镜视野范围大、灵活性好以及视野方便的优点。The purpose of this utility model is to overcome the above-mentioned deficiencies of the prior art, and to provide a special retractor for thyroid endoscopy with a reasonable and practical structure for preventing secondary trauma, which can fully expose thyroid lesions and effectively avoid secondary trauma during surgery. The occurrence of traumatic conditions, and simultaneously have the advantages of a large field of vision, good flexibility and convenient field of vision.
为实现上述目的，本实用新型采用了以下技术方案：To achieve the above object, the utility model adopts the following technical solutions:
一种防二次创伤型腔镜甲状腺专用拉钩，包括供手握持的手杆以及布置于手杆顶端的钩头；所述钩头包括由手杆顶端水平延伸的第一直杆、由第一直杆顶端水平延伸的第二直杆以及由第二直杆顶端水平延伸的第三直杆，所述第三直杆与第一直杆间存有便于第三直杆作穿刺动作的活动间隙，第一直杆、第二直杆与第三直杆共同配合形成三角状支撑面，且该三角状支撑面与手杆间彼此相交设置；各直杆均为彼此管腔依序衔接的空心管，各直杆管腔沿手杆杆体向上延伸并与手杆处预设的负压吸引孔相连通；本拉钩还包括与第三直杆同轴的切割钉；以第三直杆的与第二直杆配合端为尾端而另一端为首端，切割钉上设置外螺纹段，切割钉由第三直杆的尾端穿入并与第三直杆管腔处预设的内螺纹段间构成螺纹配合，切割钉的首部刃端伸出第三直杆的顶端以便刺破或割开患者颈前皮肤和/或颈前肌群。A special retractor for thyroid gland of an anti-secondary trauma type endoscope, comprising a hand rod for holding by a hand and a hook head arranged at the top of the hand rod; the hook head comprises a first straight rod horizontally extending from the top of the hand rod, A second straight rod extending horizontally from the top of the straight rod and a third straight rod extending horizontally from the top of the second straight rod, there is a movement between the third straight rod and the first straight rod to facilitate the puncturing action of the third straight rod Clearance, the first straight rod, the second straight rod and the third straight rod cooperate together to form a triangular support surface, and the triangular support surface and the hand rod intersect with each other; each straight rod is connected to each other in sequence The hollow tube, each straight rod lumen extends upward along the handle rod body and communicates with the preset negative pressure suction hole at the handle rod; the draw hook also includes a cutting nail coaxial with the third straight rod; The end that is matched with the second straight rod is the tail end and the other end is the head end. The cutting nail is provided with an external thread segment, and the cutting nail is penetrated by the tail end of the third straight rod and is connected with the preset internal thread at the lumen of the third straight rod. A thread fit is formed between the segments, and the leading edge end of the cutting nail protrudes from the top end of the third straight rod so as to pierce or incise the anterior neck skin and/or anterior neck muscle group of the patient.
优选的，所述切割钉的首部刃端外形呈便于切割的刀片状；所述切割钉包括构成尾部的螺钉段以及构成顶部的刃体；第三直杆的首端封闭并留有供切割钉的首部刃端伸出以及定位该首部刃端位置的避让缝，在避让缝两侧的第三直杆的首端处贯穿设置有连通第三直杆管腔与外部环境以便辅助吸液的液流孔；螺钉段顶端面处同轴凹设沉孔，刃体沿螺钉段轴线而向沉孔处延伸设置有与沉孔适配的连接杆，所述连接杆外形呈二段式阶梯轴状，沉孔孔底处同轴设置供连接杆的大直径段卡入的环形凹槽，以使得连接杆轴肩止口配合于沉孔的孔肩处。Preferably, the shape of the head end of the cutting nail is in the shape of a blade that is convenient for cutting; the cutting nail includes a screw segment forming a tail and a blade body forming a top; the head end of the third straight rod is closed and reserved for cutting nails The head edge of the head extends out and the avoidance slit for locating the position of the head edge, and the head end of the third straight rod on both sides of the avoidance slit is provided with a liquid connecting the lumen of the third straight rod and the external environment to assist the suction. Flow hole; a counterbore is coaxially concave on the top surface of the screw segment, and the blade body extends along the axis of the screw segment to the counterbore with a connecting rod adapted to the counterbore, and the shape of the connecting rod is a two-stage stepped shaft. The bottom of the counterbore hole is coaxially provided with an annular groove for the large diameter section of the connecting rod to be inserted into, so that the shoulder of the connecting rod is matched with the hole shoulder of the counterbore.
优选的，所述螺钉段的钉身中段同轴设置环形凸起，且环形凸起外壁布置所述外螺纹段，第三直杆管腔中段处相应设置所述内螺纹段。Preferably, an annular protrusion is arranged coaxially in the middle section of the screw body of the screw segment, the outer thread section is arranged on the outer wall of the annular protrusion, and the inner thread section is correspondingly arranged at the middle section of the lumen of the third straight rod.
优选的，切割钉的首部刃端的刃尖到第三直杆的首端之间的间距等于患者颈前待切割深度。Preferably, the distance between the cutting edge of the cutting nail's head cutting edge and the head end of the third straight rod is equal to the depth to be cut in front of the patient's neck.
优选的，所述第三直杆的首端处套设有用于遮蔽切割钉的首部刃端的保护封盖。Preferably, the head end of the third straight rod is sleeved with a protective cover for shielding the head edge of the cutting nail.
优选的，所述手杆与三角状支撑面间呈钝角设置，且两者夹角为165°。Preferably, the handle bar and the triangular support surface are arranged at an obtuse angle, and the included angle between the two is 165°.
优选的，切割钉的螺帽处设置有便于手握施力的防滑纹路。Preferably, the nut of the cutting nail is provided with an anti-slip texture that is convenient for hand grip and force.
本实用新型的有益效果在于：The beneficial effects of the present utility model are:
1)、本实用新型解决了传统拉钩自带尖锐顶端所易于导致二次创伤的固有缺陷，立足于本身穿刺切割操作独立于撑开操作之前的操作流程，通过将实行穿刺切割的操作部与用于撑开患者颈前肌群的的钩头进行人为分离，并另辟蹊径的将操作部巧妙变型为螺钉构造，从而实现了需穿刺切割则使用切割钉，而穿刺切割完毕则通过螺纹配合而卸除切割钉的特殊操作流程。由于切割钉的可卸除性，同时圆润的钩头本身不具备尖锐特性，也就完全不存在术时的二次创伤的可能性。更需值得注意的是，由于本实用新型兼顾了术时的负压抽吸功能，也即术时的出血可经由各彼此连通的直杆管腔被负压抽吸出去，而切割钉则直接利用第三直杆的管腔来达到容纳功能。上述切割钉与第三直杆的特殊配合方式，一方面保证了切割钉的巧妙安置，无需额外附属部件；同时切割钉与第三直杆彼此同轴也能确保穿刺切割后的颈前肌群及皮肤处刀口刚好适宜第三直杆穿入；另一方面，一旦切割钉拔出，第三直杆的两端管口即形成了血液抽入口，显然也不会影响本实用新型的血液负压吸取操作，一举多得。1), the utility model solves the inherent defect of the traditional retractor with its own sharp top that is easy to cause secondary trauma, based on its own puncture and cutting operation independent of the operation process before the opening operation, by combining the operation part for puncturing and cutting with the user; The hook head that stretches the patient's anterior neck muscle group is artificially separated, and the operating part is cleverly transformed into a screw structure in a new way, so that the cutting nail is used for puncture cutting, and the puncture and cutting are completed. Special operating procedures for cutting nails. Due to the detachability of the cutting nail, and the rounded hook head itself does not have sharp characteristics, there is no possibility of secondary trauma during surgery. It should be noted that, because the present utility model takes into account the negative pressure suction function during the operation, that is, the bleeding during the operation can be sucked out by the negative pressure through the straight rod lumens that communicate with each other, while the cutting nails are directly sucked out. Use the lumen of the third straight rod to achieve the containment function. The above-mentioned special matching method of the cutting nail and the third straight rod, on the one hand, ensures the ingenious placement of the cutting nail without additional accessory parts; at the same time, the cutting nail and the third straight rod are coaxial with each other to ensure the anterior cervical muscle group after puncture and cutting On the other hand, once the cutting nail is pulled out, the two ends of the third straight rod form a blood suction port, which obviously will not affect the blood negative of the present invention. Press and suck operation, serve multiple purposes with one fell swoop.
2)、为便于进行颈前皮肤及肌群的剖切，并确保颈前皮肤及肌群的后期快速愈合，本实用新型优选切割钉的首部刃端为刀片状而不是尖刺状。避让缝的设置有两点好处：其一在于避让缝能起到固定和限位易折的切割钉的首部刃端伸出路径的目的，通过避让缝的缝隙方向来保证切割钉的刃口方向，且避让缝能同时夹住切割钉的首部刃端而使其不至于受力弯折甚至折断，以便于实际切割。其二在于避让缝配合液流孔，能使得第三直杆的首端在作为探入端而伸入颈前肌群内时不会被肌肉组织等阻塞，以确保其血液吸取效率。由于切割钉的首部刃端位置有所限定，因此特别还设置有螺钉段与连接杆的卡接结构，以确保在切割钉旋转时，切割钉的首部刃端不会产生随动转动，再配合上述避让缝，也即保证切割钉的首部刃端仅能沿第三直杆的轴长方向作往复动作，而无法作回转动作，最终确保切割钉的切割可靠性。2), in order to facilitate the incision of the skin and muscle group in front of the neck, and ensure the rapid healing of the skin and muscle group in front of the neck, the preferred cutting edge of the present invention is a blade shape rather than a thorn shape. The setting of the avoidance seam has two advantages: one is that the avoidance seam can play the purpose of fixing and limiting the protruding path of the leading edge of the cutting nail which is easy to fold, and the direction of the cutting edge of the cutting nail can be guaranteed by the direction of the gap of the avoidance seam. , and the avoidance seam can clamp the head edge of the cutting nail at the same time, so that it will not be bent or even broken under force, so as to facilitate the actual cutting. The second is to avoid the suture and the liquid flow hole, so that the head end of the third straight rod will not be blocked by muscle tissue when it is inserted into the anterior neck muscle group as a probe end, so as to ensure its blood absorption efficiency. Since the position of the head edge of the cutting nail is limited, a clamping structure between the screw segment and the connecting rod is specially provided to ensure that when the cutting nail rotates, the head cutting edge of the cutting nail will not follow the rotation. The above-mentioned avoidance seam ensures that the cutting nail's head blade end can only reciprocate along the axial length direction of the third straight rod, but cannot rotate, and finally ensures the cutting reliability of the cutting nail.
3)、外螺纹段与内螺纹段的配合应当深置于第三直杆的管腔中段，而不是通常的管腔两端。之所以采用上述设计，是考虑到在第三直杆的管腔端部配螺纹，会影响到相应杆端的光滑性，从而会对实际穿刺切割作业产生影响。切割钉的首部刃端的刃尖到第三直杆的首端之间的间距等于患者颈前待切割深度，该间距可以通过上述外螺纹段相对内螺纹段的拧动动作来调节，以便于术时能以第三直杆的首端封闭所在面为定位面，直接将该切割钉的首部刃端直接刺入颈部肌群并以定位面来抵住患者颈前皮肤而快速切割，此时首部刃端的刺入深度即为术时需切割深度，其使用即为便捷。3) The mating between the external thread segment and the internal thread segment should be placed deep in the middle of the lumen of the third straight rod, not at both ends of the usual lumen. The reason why the above-mentioned design is adopted is that threading on the lumen end of the third straight rod will affect the smoothness of the corresponding rod end, thereby affecting the actual puncture and cutting operation. The distance between the blade tip of the cutting nail's head blade end and the head end of the third straight rod is equal to the depth to be cut in front of the patient's neck. When the head end of the third straight rod is closed, it can be used as the positioning surface, and the cutting nail's first blade end can be directly inserted into the neck muscle group and the positioning surface can be pressed against the skin in front of the patient's neck for rapid cutting. The penetration depth of the first blade end is the required cutting depth during surgery, and its use is convenient.
4)、保护封盖的设置目的，是用于初始来保护切割钉的首部刃端，以避免在使用之前的出现刃口碰损或意外割伤状况。手杆与三角状支撑面间呈钝角而不是常见的直角，钝角结构的设置使得手杆整体施力更为轻便，并在三角状支撑面完全伸入患者的颈部肌群后，能通过对手杆的施力而更好的向外向上的牵拉颈部肌群，从而使病灶区域暴露呈现最大化。4) The purpose of setting the protective cover is to initially protect the head edge of the cutting nail, so as to avoid edge collision or accidental cutting before use. There is an obtuse angle between the hand lever and the triangular support surface instead of the common right angle. The obtuse angle structure makes the overall force of the hand lever easier to apply, and after the triangular support surface is fully extended into the patient's neck muscles, it can pass the hand. The force of the rod can better pull the neck muscles outward and upward, so as to maximize the exposure of the lesion area.
附图说明Description of drawings
图1为本实用新型的结构俯视图；Fig. 1 is the structure top view of the utility model;
图2为图1的剖视图；Fig. 2 is the sectional view of Fig. 1;
图3为图2的I部分局部放大图；Fig. 3 is a partial enlarged view of part I of Fig. 2;
图4为第三直杆的首端端面示意图；4 is a schematic view of the head end face of the third straight rod;
图5为去除切割钉后的本实用新型的结构剖视图；5 is a cross-sectional view of the structure of the present invention after removing the cutting nail;
图6为切割钉的结构示意图；Fig. 6 is the structural representation of cutting nail;
图7为图6的A-A向剖面图的等比例放大图；7 is an isometric enlarged view of the cross-sectional view taken along the line A-A of FIG. 6;
图8为图1的仰视图。FIG. 8 is a bottom view of FIG. 1 .
本实用新型各标号与部件名称的实际对应关系如下：The actual corresponding relationship between the labels of the present utility model and the names of the components is as follows:
10-手杆 11-负压吸引孔10-hand lever 11-negative pressure suction hole
20-钩头 21-第一直杆 22-第二直杆 23-第三直杆20-Hook head 21-First straight rod 22-Second straight rod 23-Third straight rod
23a-避让缝 23b-液流孔 23c-内螺纹段23a-
30-切割钉 31-螺钉段 31a-环形凹槽 31b-外螺纹段30-cutting nail 31-
32-刃体 32a-连接杆32-
40-保护封盖40 - Protective cover
具体实施方式Detailed ways
为便于理解，此处结合附图，对本实用新型的具体结构及工作方式作以下进一步描述：For ease of understanding, the specific structure and working mode of the present utility model are further described below in conjunction with the accompanying drawings:
本实用新型的具体实施结构参照图1-8所示，其主体结构包括手杆10以及位于手杆10顶端的由第一直杆21、第二直杆22及第三直杆23所构成的三角状支撑面。在第三直杆23的管腔内还穿设和螺纹配合有切割钉30，以实现颈部肌群撑开前的切割颈部皮肤及肌群操作。具体而言：1-8, the main structure of the present invention includes a
如图1-2及图5和图8所示，对于手杆10而言，其更多是作为便于手握持的握持杆而使用。在必要时，可对手杆10作相应改进，如增加握把等结构，以使其使用更为便捷。在手杆10顶端安置各直杆所形成的三角状支撑面时，需注意手杆10与三角状支撑面应当呈现如图8所示的钝角结构，以使其施力更为方便。优选方案中，手杆10与三角状支撑面间夹角为165°，也即图8中的夹角a为15°，从而更方便将肌群向外向上同时牵拉。As shown in FIGS. 1-2 and FIGS. 5 and 8 , for the
切割钉30的设置为本实用新型的重点部分。在安置切割钉30之前，本实用新型首先将第一直杆21、第二直杆22及第三直杆23全部挖空从而形成直管结构。换言之，由第三直杆23的首端涌入血液，血液能沿第三直杆23的管腔而依序穿行至第二直杆22及第一直杆21管腔内，并最终经由手杆10处管腔而由负压吸引孔11处被吸出，以实现本实用新型的血液负压吸引作业。在上述作业的基础上，本实用新型又利用了第三直杆23的管腔结构，通过在第三直杆23的管腔中段布置如图5所示的内螺纹段23c，并在切割钉30的螺钉段31的中段杆身处布置外螺纹段31b，以实现切割钉30相对第三直杆23的螺纹拧入及拧出操作。与此同时的，切割钉30被分为构成尾部的螺钉段31以及构成顶部的刃体32。为便于进行颈前皮肤及肌群的剖切，并确保颈前皮肤及肌群的后期快速愈合，本实用新型优选切割钉30的首部刃端为刀片状而不是尖刺状。如图4所示的避让缝23a的设置有两点好处：其一在于避让缝23a能起到固定和限位易折的切割钉30的首部刃端伸出路径的目的，通过避让缝23a的缝隙方向来保证切割钉30的刃口方向，且避让缝23a能同时夹住切割钉30的首部刃端而使其不至于受力弯折甚至折断，以便于实际切割。其二在于避让缝23a配合液流孔23b，能使得第三直杆23的首端在作为探入端而伸入颈前皮肤及肌群内时不会被肌肉组织等阻塞，以确保其血液吸取效率。由于切割钉30的首部刃端位置有所限定，因此特设螺钉段31与连接杆32a的卡接结构，具体参照图2及图7所示，以确保在切割钉30旋转时，切割钉30的首部刃端不会产生随动转动，再配合上述避让缝23a，也即保证切割钉30的首部刃端仅能沿第三直杆23的轴长方向作往复动作，而无法作回转动作，最终确保切割钉30的切割可靠性。本实用新型还如图2及图7所示的布置有保护封盖40，以起到对锋利的切割钉30的首端刃口的保护目的。The arrangement of the cutting nails 30 is an important part of the present invention. Before placing the cutting
为便于进一步理解本实用新型，此处给出本实用新型的具体操作流程如下：For the convenience of further understanding of the present utility model, the specific operation process of the present utility model is provided here as follows:
本实用新型在术前准备阶段时，其整体呈现如图1-2所示状态。当需要执行腔镜甲状腺手术时，首先打开保护封盖40从而暴露出切割钉30的首端刃口，通过拧动切割钉30，使得切割钉30相对第三直杆23转动，从而控制上述首端刃口的露出长度。操作切割钉30的首端刃口切割患者的颈前皮肤甚至是颈前肌群，待观察切割刀口足以塞入第三直杆23后，拧动切割钉30从而使其脱离第三直杆23的管腔，最终拔出切割钉30。取出切割钉30的本实用新型参照图5所示。之后，即可按照第三直杆23、第二直杆22及第一直杆21的顺序，而沿上述切割刀口逐个塞入相应杆身，直至钩头20能完全透过切割刀口而伸入颈前肌群处，并能将位于甲状腺前方的颈前肌群完全拉开。由于手杆10与三角状支撑面的特殊角度，因此，通过调节对手杆10的施力方向，能更易于拉开甲状腺前方的颈前肌群。When the utility model is in the preoperative preparation stage, its overall appearance is as shown in Figure 1-2. When laparoscopic thyroid surgery needs to be performed, the
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| CN109758195A (en)* | 2019-01-28 | 2019-05-17 | 安徽医科大学第一附属医院 | A special retractor for the thyroid gland of an anti-secondary trauma type endoscopic |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN109758195A (en)* | 2019-01-28 | 2019-05-17 | 安徽医科大学第一附属医院 | A special retractor for the thyroid gland of an anti-secondary trauma type endoscopic |
| CN109758195B (en)* | 2019-01-28 | 2024-08-23 | 安徽医科大学第一附属医院 | Special retractor for preventing secondary trauma of cavity mirror thyroid gland |
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