Miccoli术式对甲状旁腺及其功能保护的临床研究

Protection of parathyroid glands and their function by Miccoli operation

目的 探讨Miccoli术式在甲状腺手术中对甲状旁腺辨识及其功能保护的优劣性.方法 选取福建医科大学附属协和医院甲状腺外科行Miccoli术式全甲状腺切除术24例,同期行传统开放术式全甲状腺切除术43例,比较2组术式术前及术后第1天、第3天血清甲状旁腺素（parathyroid hormone,PTH）及血清钙离子（Ca2＋）浓度的变化;同时比较术中对甲状旁腺辨识个数,术后一过性及永久性甲状旁腺功能减退症发生率.结果 Miccoli术式组术中对甲状旁腺的辨识个数（3.33 ±0.70）高于开放术式组（2.86±0.71）,差异有统计学意义（P＜0.05）;术后第1天、第3天2组血清PTH及Ca2＋浓度均明显下降,不同手术方式PTH水平变化趋势存在差异,差异有统计学意义（P＜0.05）,Miccoli术式组不同时相PTH水平较为稳定.Miccoli术式组一过性（9/24）及永久性（0/24）甲状旁腺减退者相对开放术式组（27/43,1/43）少,差异有统计学意义（P＜0.05）.结论 Miccoli术式能减少手术对甲状旁腺及其功能的影响,有利于甲状旁腺功能的恢复,较开放术式更具有优势.

Objective To discuss the advantages and disadvantages of Miccoli operation in identification of parathyroid and its function protection in thyroid surgery.Methods 24 cases undergoing Miccoli operation and 43 cases in the corresponding period undergoing open surgery of total thyroidectomy in Department of Thyroid Surgery,fujian medical university affiliated union hospital were selected.Data of the two groups in parathyroid hormone（PTH）and serum calcium before operation and the 1st and 3rd day after operation were compared.The number of parathyroid gland were identified and the occurrence rate of transient and permanent hypoparathyroidism were compared.Results The identification number of parathyroid was higher in Miccoli operation group（3.33 ±0.70） than in open surgery group（2.86 ± 0.71）.The difference had statistical significance（P ＜ 0.05）.The level of PTH and serum calcium reduced in the 1st and 3rd after operation.There were differences between different operation methods in level of PTH change trend and the difference was statistically significant（P ＜0.05）.PTH level in Mic coli operation group was more stable.There were less case of transient or permanent hypoparathyroidism in Miccoli operation and the difference had statistical significance（P ＜ 0.05）.Conclusion Miccoli operation have more advantages in parathyroid identification and its function protection compared with open surgery.