分化型甲状腺癌手术中暴露并保护甲状旁腺的必要性分析

Study on the necessity to find and protect the parathyroid glands in the differentiated thyroid cancer surgery

目的探讨分化型甲状腺癌手术中暴露并保护甲状旁腺的必要性。方法对首次收治的两组分化型甲状腺癌患者进行手术,第1组243例患者保留甲状腺后被膜,未寻找甲状旁腺;第2组260例患者暴露并保护甲状旁腺,保留甲状旁腺的血供,两组患者再依据病灶情况采用3种术式,分别为术式1、2、3组,观察术后甲状旁腺的功能情况。结果在术中暴露并保护甲状旁腺组中,采用术式2和术式3的患者,术后甲状旁腺功能低下的发生率较未寻找甲状旁腺组患者明显降低,两组比较有统计学意义(P<0.05)。结论在分化型甲状腺癌手术中,尤其是甲状腺叶全部切除和单侧甲状腺叶切除加对侧甲状腺叶大部分或次全切除术中,暴露并保护甲状旁腺,可有效降低术后甲状旁腺功能低下的发生率。

OBJECTIVE To study the necessity of finding and protecting parathyroid glands in the differentiated thyroid cancer surgery. METHODS The parathyroid function of the patients with differentiated thyroid cancer after surgery was studied. They were both diagnosed for the first time. The back capsule of thyroid was reserved and the parathyroid glands were not looking for in 243 cases. The parathyroid glands were exposed and protected,and their blood supply was reserved in 260 cases. And then three types of operations were applied in the two groups according to their conditions. RESULTS Postoperative incidence of hypoparathyroidism in patients with exposing and protecting parathyroid glands,especially in patients using operation 2 and 3,was significantly lower than that in patients without finding parathyroid glands（P0.05）. CONCLUSION In differentiated thyroid cancer surgery,especially in total thyroidectomy and unilateral thyroid lobectomy plus the majority or near total of contralateral lobectomy,exposing and protecting the parathyroid gland can effectively decrease the incidence of postoperative hypoparathyroidism.