甲状腺全切手术中甲状旁腺的保护

Preservation of parathyroid during the thyroidectomy

目的 探讨甲状腺全切除手术中甲状旁腺辨认与保护方法,避免术后永久性甲状旁腺功能减退的发生.方法 连续选取2013年6月至2014年6月期间117例行甲状腺精细化手术的病例,对其中43例甲状腺全切除手术病例（甲状腺癌26例,结节性甲状腺肿17例）进行回顾性分析.结果 术中4枚甲状旁腺均确认者27例,3枚甲状旁腺确认者10例,2枚甲状旁腺确认者6例.术中甲状旁腺移植6例,5例行1枚甲状旁腺移植,1例行2枚甲状旁腺移植.术后甲状旁腺激素（parathyroid hormone,PTH）正常,血钙正常者25例;PTH正常,一过性血钙下降者10例;暂时性甲状旁腺功能减退（PTH下降,血钙下降伴有临床低钙血症症状者）8例.术后随访1～3个月,无一例患者出现永久性甲状旁腺功能减退.结论 在甲状腺全切除术中,利用被膜精细解剖技术,准确辨认甲状旁腺并原位保护或自体移植,是避免永久性甲状旁腺功能减退的有效方法.

Objective To investigate the protection of the parathyroid in the total thyroidectomy to avoid the postoperative permanent hypoparathyroidism.Methods Forty-three consecutive cases underwent total thyroidectomy from June 2013 to June 2014 in Nanjing Tongren Hospital were reviewed.Of them 26 cases with malignant and 17 cases with benign thyroid diseases.Results Intraoperatively,all 4 parathyroid glands were identified in 27 cases,3 parathyroids in 10 cases and 2 parathyroids in 6 cases.Intraoperative parathyroid transplantation was performed in 6 cases,including 5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation.With the follow-up of 1-3 months after surgery,10 cases presented with transient hypocalcemia,8 cases with temporary hypoparathyroidism and no case with permanent hypoparathyroidism.Conclusion Accurate identification and conservation in situ or auto-transplantation in total thyroidectomy could be effective for prevention of postoperative permanent hypoparathyroidism.