甲状腺癌再手术中甲状旁腺损伤及功能保护方法

Preservation of parathyroid glands and their functions during reoperation of thyroid carcinoma

目的探讨甲状腺癌再手术中甲状旁腺损伤及功能保护方法。方法回顾性分析德阳市人民医院胃肠甲状腺外科2012年1月至2017年3月收治的39例甲状腺癌再手术患者的病例资料，距初次手术在3个月以内接受再次手术的17例分为A组，另外22例在3个月以上接受再次手术的分为B组，观察并记录2组意外切除甲状旁腺（inadvertent parathyroidectomy, IPE）和缺血甲状旁腺的数目、纳米碳负显影染色情况,监测血钙及甲状旁腺激素（parathyroid hormone, PTH）水平。结果A组中10例发生IPE（7枚甲状旁腺术中解剖标本发现，3枚甲状旁腺术后病理报告提示），4枚原位保留甲状旁腺发生缺血；B组中4例发生IPE（4枚甲状旁腺均术中解剖标本发现），3枚原位保留甲状旁腺发生缺血。对术中解剖标本发现的意外切除的甲状旁腺和缺血的甲状旁腺均行自体移植：A组中一共移植11枚甲状旁腺（7例行1枚旁腺移植，2例行2枚旁腺移植）；B组中一共移植7枚甲状旁腺（5例行1枚旁腺移植，1例行2枚旁腺移植）。A组甲状旁腺意外切除率58.8%（10/17），B组甲状旁腺意外切除率18.2%（4/22），A组明显高于B组（P〈0.05）。术后暂时性甲状旁腺功能减退的发生率：A组52.9%（9/17）明显高于B组18.2%（4/22）（P〈0.05）。术后随访3~6个月，无一例出现永久性甲状旁腺功能减退。结论选择合适再次手术时机结合纳米碳负显影在甲状腺癌再次手术中能减少甲状旁腺的意外切除，必要的甲状旁腺自体移植能有效减少术后永久性甲状旁腺功能减退的发生。

ObjectiveTo investigate the protection of parathyroid glands and their functions during reoperation of thyroid carcinoma. MethodsThe clinical data of 39 patients who underwent reoperation of thyroid carcinoma from Jan. 2012 to Mar. 2017 in our hospital were studied retrospectively. They were divided into two groups （group A： 17 patients who underwent reoperation within 3 months from initial operation; group B： 22 patients who underwent reoperation 3 months or longer since the first operation） . The numbers of parathyroid including inadvertent parathyroidectomy （IPE） and ischemic parathyroid, and the dyeing conditions in the two groups were observed and recorded respectively. Serum calcium and parathyroid hormone （PTH） levels were determined after operation.ResultsIn group A, 10 cases with IPE （7 parathyroid glands were found intraoperative dissection specimens, 3 parathyroid glands postoperatieve pathology confirmed） , 4 parathyroid glands in situ were found ischemia; In group B, 4 cases with IPE （4 parathyroid glands were found intraoperative dissection specimens） , 3 parathyroid glands in situ were found ischemia. All of IPE found through intraoperative dissection and ischemic parathyroid glands were transplanted. A total of 11 parathyroid glands were transplanted in group A （7 cases with 1 parathyroid transplantation and 2 cases with 2 parathyroid transplantation） . The number of parathyroid gland transplants in group B was 7 （5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation） . The rate of IPE in the group A was 58.8% （10/17） , significantly higher than 18.2% （4/22） in the group B （P〈0.05） ; The rate of temporary hypoparathyroidism in the group A was 52.9% （9/17） , significantly higher than in the group B 18.2% （4/22） （P〈0.05） ;With the follow-up of 3~6 months after surgery, no case with permanent hypoparathyroidism.ConclusionSelect the appropriate reoperation time combined the nano-carbon negative development during the reoperation of thyroid carcinoma, can reduce IPE; necessary parathyroid transplantations are effective measures to avoid the postoperative permanent hypoparathyroidism.