内镜甲状腺手术对甲状旁腺的辨别与保护研究

Identification and protection of parathyroid glands in video-assisted endoscopic thyroid surgery

目的探讨在内镜甲状腺手术中辨别和保护甲状旁腺的方法。方法回顾性分析2006年10月至2010年7月160例行颈前小切口内镜辅助甲状腺手术患者的临床资料,其中甲状腺瘤58例,结节性甲状腺肿82例,原发性甲状腺功能亢进16例,甲状腺乳头状癌4例。行一侧甲状腺次全切除术90例,双侧甲状腺次全切除术46例,甲状腺全切术20例,甲状腺全切术+中央组淋巴结清扫4例,术中均对甲状旁腺进行精确辨认及有效保护。结果 160例均成功完成手术,术后暂时性甲状旁腺功能减退4例(2.5%),未出现永久性甲状旁腺功能减退。结论内镜辅助甲状腺手术在术中可通过内镜放大作用对甲状旁腺进行精确辨认,并在内镜视野下完成对甲状旁腺血供的精细解剖和分离,有效的保护了甲状旁腺及其血供,明显降低了术后甲状旁腺功能减退并发症的发生率。

Objective To investigate the technique of identification and protection of parathyroid glands in video-assisted endoscopic thyroid surgery.Methods From October 2006 to July 2010,160 patients with thyroid diseases received endoscopic thyroidectomy via cervical single small incision were analyzed retrospectively.There were 58 cases of thyroid tumor,82 cases of nodulargoiter,16 cases of primary hyperthyroidism,4 cases of papillary thyroid cancer.Ninety cases were performed subtotal unilateral lobectomy,46 cases were performed subtotal bilateral thyroidectomy,20 cases were performed total thyroidectomy,4 cases were performed total thyroidectomy and lymph node dissection of central group.The parathyroid glands were discerned accurately and protected effectively in operations.Results Operations were successfully peformed in 160 cases.There was no permanent hypoparathyroidism occurred after operation,but 4 cases occurred temporary hypoparathyroidism（2.5 %）.Conclusions The parathyroid glands can be discerned accurately by magnification in video-assisted endoscopy,its artery blood-supply can also be exposed and separated subtly in view of video-assisted endoscopy,so the parathyroid glands and its blood-supply can be protected perfectly to prevent hypoparathyroidism after operation.