甲状腺全切除术中甲状旁腺的辨识和保护

Identification and protection of parathyroid glands in total thyroidectomy

目的:探讨并总结甲状腺全切除术中甲状旁腺的辨识和保护方法。方法:对2003年3月—2013年3月收治的3 425例行甲状腺全切除术患者的临床资料进行回顾性分析。结果:全组男489例,女2 936例,年龄9～72岁。结节性甲状腺肿2 261例,甲状腺癌684例,原发性甲状腺功能亢进症(甲亢)92例,结节性甲状腺肿继发甲亢57例,甲状腺腺瘤41例,肉芽肿性甲状腺炎31例,桥本氏病259例。行甲状腺单侧叶全切除术364例,甲状腺双侧叶全切除术3 061例,颈部淋巴结廓清术186例,甲状旁腺异位自体移植术834例。住院时间5～8 d,术后随访2个月至10年,无永久性甲状旁腺功能减低出现,疗效满意。结论:甲状旁腺解剖位置特殊、形态复杂多样。甲状腺全切除术中,术者应精细操作、仔细分离、沿预留组织解剖、保持术野干燥,准确辨识并保护甲状旁腺,从而有效降低永久性甲状旁腺功能减低的发生率。

Objective： To investigate and summarize the measures for identification and protection of parathyroid glands in total thyroidectomy （＇IT）. Methods： The clinical data of 3 425 patients who underwent TT from March 2003 to March 2013 were analyzed retrospectively. Results： Of the entire group of patients, 489 cases were male and 2 936 cases were female, and their ages ranged from 9 to 72 years; operation was performed in 2 261 cases of nodular goiter, 684 cases of thyroid cancer, 92 cases of primary hyperthyroidism, 57 cases of hyperthyroidism resulting from a nodular goiter, 41 cases of thyroid adenoma, 31 cases ofgranulomatous thyroiditis, and 259 cases of Hashimoto＇s disease; 364 cases underwent unilateral TT and bilateral TF was done in 3 061 cases; 186 cases underwent neck dissection and 834 cases received parathyroid autotransplantation. The length of postoperative hospital stay was 5 to 8 d and postoperative follow-up period ranged from 2 months to 10 years; there were no cases of permanent hypoparathyroidism and the efficacy of treatment was satisfactory. Conclusion： The parathyroid glands have special anatomical features, with complicated and diverse shapes. During TF, surgeons should operate meticulously6 dissect along the tissue planes, and keep a clean operative field so as to accurately identify and protect the parathyroid glands and avoid damaging them, which may effectively reduce the incidence of permanent hypoparathyroidism.