甲状腺全切除术中对甲状旁腺特异性附着脂肪进行保护的临床和解剖分析

Clinical and anatomic analysis of parathyroid specific attachment fat protection during total thyroidectomy

目的探析甲状腺全切除术中对甲状旁腺特异性附着脂肪进行保护的临床特征以及解剖特点。方法选择2013年1月~2016年12月本院接受甲状腺全切除术治疗的患者50例,术前实施超声检查,术中分析高清图像,术后实施病理检查,以对甲状旁腺微血管结构的分布来源以及特异性附着脂肪的特点进行记录。另外术中应用甲状旁腺特异性附着脂肪保护技术,分析手术前后血磷、血钙、甲状旁腺素的变化情况。结果平均手术时间为(70.7±35.6)min,平均术中出血量(20.3±10.6)m L;77.42%的甲状旁腺具有特异性附着脂肪结构;术后1个月血磷、血钙、甲状旁腺素水平结果为(1.26±0.25)mmo L/L、(2.20±0.14)mmo L/L、(30±16)ng/L,术前为(1.27±0.20)mmol/L、(2.23±0.10)mmol/L、(39±17)ng/L。结论甲状腺全切除术中通过特异性附着脂肪保护技术的应用,能够对甲状旁腺的正常微血管结构及其功能给予更有效保护,降低永久性甲状旁腺功能减退的发生率。

Objective To investigate the clinical characteristics and anatomical characteristics of parathyroid specific attachment fat during total thyroidectomy.Methods Fifty cases of total thyroidectomy in our hospital from January 2013 to December 2016 were selected.Ultrasound examination was performed before operation,high definition images were analyzed in operation and pathological examination was carried out after operation to record the distribution of parathyroid microvascular structure and the characteristics of specific attached fat.In addition,parathyroid specific attachment fat protection technique was applied to analyze the changes of blood phosphorus,blood calcium and parathyroid hormone before and after operation.Results The mean operative time was(70.7±35.6)min,and the average intraoperative blood loss was(20.3±10.6)mL.77.42%of the parathyroid glands had specific attachment fat structure.The blood phosphorus,blood calcium and parathyroid hormone levels were(1.26±0.25)mmoL/L,(2.20±0.14)mmoL/L and(30±16)ng/L after the operation,respectively the preoperative was(1.27±0.20)mmol/L,(2.23±0.10)mmol/L and(39±17)ng/L.Conclusion The use of specific attached fat protection techniques during total thyroidectomy can protect the normal microvascular structure and function of parathyroid glands more effectively and reduce the incidence of permanent parathyroid hypogonadism.