甲状腺肿瘤手术中暴露并保护甲状旁腺的解剖与手术操作要点

Preservation of parathyroid gland during the resection of thyroid neoplasms: anatomy and operative procedure

目的探讨甲状腺肿瘤手术中暴露并保护甲状旁腺的要点。方法对2004年1月至2010年12月145例甲状腺弥漫性结节和甲状腺癌患者进行手术,分前、后3年两组,前3年组65例患者保留甲状腺后被膜,未寻找甲状旁腺;后3年组80例患者暴露并保护甲状旁腺,精细解剖观察被膜,尽量保存甲状旁腺的血供及完整性。术后进行动态监测血清钙变化,观察甲状旁腺的功能情况。结果在术中暴露并保护甲状旁腺后3年组中,术后甲状旁腺功能低下的机率较未寻找甲状旁腺前3年组患者明显降低,两组比较有统计学意义(P<0.05)。结论在甲状腺肿瘤手术中,暴露并保护好甲状旁腺,可有效降低术后甲状旁腺功能低下的发生率。

Objective To explore operational points for preserving parathyroid glands during the thyroid neoplasms surgery. Methods From Jan. 2004 to Dec. 2010, 145 cases of thyroid diffuse nodules and thyroid cancer underwent surgical therapy. Among them, 65 cases only preserved posterior capsule, but not presented parathyroid glands during the operation. However, another 80 cases were performed the liberation and preservation of parathyroid glands and its blood supply during the operation. Postoperative serum calcium level was monitored dynamicly, for evaluating the function of parathyroid glands. Results Postoperative incidence of hypoparathyroidism in patients exposing and preserving of parathyroid glands during the operation was significantly lower than that in patients with no special preserving of parathyroid glands （P〈0.05）. Conclusions During the thyroidectomy procedure, exposing and protecting the parathyroid gland can effectively decrease the incidence of postoperative hypoparathyroidism.