双侧甲状腺乳头状癌术中甲状旁腺保护的诊治体会

Parathyroid protection in surgery of bilateral papillary thyroid cancer

目的 探讨双侧甲状腺乳头状癌行甲状腺全切除术＋双侧中央区颈清扫术术中甲状旁腺的保护.方法 回顾性分析2013年5月至2014年5月北京大学肿瘤医院头颈外科收治的双侧甲状腺乳头状癌行甲状腺全切除术＋双侧中央区颈清扫术且临床随访资料完整的甲状腺乳头状癌患者78例的病历资料.结果 78例患者共发现并原位保护上甲状旁腺131个,其中位于甲状软骨下角水平有112个（85.50％,112/131）,甲状腺背侧中上1/3水平及稍上方有19个（14.50％,19/131）.所有上甲状旁腺均位于喉返神经入喉点向下2 cm这一段神经的上方或外上方.共发现并保护下甲状旁腺110个,在下动脉上方甲状腺背侧（甲状腺背侧下1/3区域）发现下甲状旁腺57个（51.82％,57/110）;在下动脉表面附近发现下甲状旁腺24个（21.82％,24/110）;在下动脉下方发现下甲状旁腺29个（26.36％,29/110）.在中央区颈清扫标本中发现被切除的甲状旁腺并行即刻自体移植的有3个,在病理报告中发现甲状旁腺的有7个.27例发现4个甲状旁腺（34.62％,27/78）,30例发现3个,16例发现2个,5例发现1个（4例发现1个上甲状旁腺,1例发现1个下甲状旁腺）.结论 双侧甲状腺乳头状癌行甲状腺全切除术＋双侧中央区颈清扫术,有效地辨认和保护旁腺的血供是预防甲状旁腺功能低下的最有效手段。

Objective To evaluate the protection of parathyroid glands in bilateral papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection.Methods The clinical data of 78 patients undergoing total thyroidectomy and bilateral central compartment dissection between May 2013 and May 2014 were analyzed retrospectively.Results Among 78 patients,131 superior parathyroid glands were protected in situ,among those,112 parathyroid glands located at the level of inferior edge of parathyroid cartilage;19 parathyroid glands located in the superior 1/3 part of the back sides of the thyroid glands.All the superior parathyroid glands located in the superior and lateral-superior part of the 2 cm part down from the entrance of recurrent laryngeal nerve.A total of 110 inferior parathyroid glands were protected in situ,among those,57 glands located in the superior of inferior thyroid artery;24 glands located just on the surface of inferior thyroid artery;29 glands located below the superior of inferior thyroid artery.Three parathyroid glands were found in the dissected tissues and were implanted immediately.Seven parathyroid glands were found with post-operative pathologic examinations.During surgery,four parathyroid glands was found in 27 patients,three in 30 patients,two in 16 patients,and one in 5 patients.Conclusion For papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection,identification of parathyroid glands and protection of blood supply to glands are the most effective methods to prevent hypoparathyroidism.