甲状旁腺血供保护在甲状腺手术中的临床意义

Clinical significance of parathyroid blood supply protection in thyroid operation

目的加强甲状腺手术中甲状旁腺血供的保护,避免甲状旁腺的损伤。方法运用囊内操作和精细化被膜解剖技术,精细被膜化解剖,紧贴腺体分支结扎甲状腺血管,尽量保留甲状腺上动脉的后支及甲状腺下动脉的上行支。术后适当使用血管扩张药物及活血药物。结果有效保护了甲状旁腺功能,无永久性甲状旁腺功能减退发生。5例出现一过性低钙血症中,双侧甲状腺次全切除术4例,单侧叶全切除+对侧叶次全切除1例,仅有的1例甲状旁腺功能减退出现在单侧叶全切除+对侧叶次全切除病例中;暂时性甲状旁腺功能减退发生率<1%,主要是一过性低钙血症,发生率为2.7%。结论施行精细甲状腺手术,严格个体化原则,最大限度地保护甲状旁腺血供,是预防术后甲状旁腺功能减退简单确切的方法。

Objective To strengthen the protection of parathyroid blood supply in thyroid operation, in order to prevent para- thyroid gland fromg damaged. Methods Cyst operation and the meticulous membrane dissection technique was used. The appro- priate operation mode was chosen to protect parathyroid blood supply. Vasodilator drugs were appropriately used after the surgery. Results Parathyroid function was effectively protected. No permanent hypoparathyroidism occurred. Conclusion Performing e- laborate thyroid operation, following the principle of individuation and protecting parathyroid blood supply as far as possible, are simple and exact methods to prevent hypoparathyroidism after the operation.