甲状腺全切术中甲状旁腺保护的诊治体会

Parathyroid protection during total thyroidectomy

目的探讨甲状腺全切术中辨认、保护甲状旁腺的方法,减少甲状旁腺损伤的可能性。方法回顾性分析大连市友谊医院耳鼻咽喉头颈外科2014年1月至2017年6月行甲状腺全切除术患者113例,术中对甲状旁腺进行仔细辨别,并行精细化被膜解剖,尽可能原位保留甲状旁腺。术中发现血供欠佳或误切除者,行带状肌或胸锁乳突肌内种植。结果术后甲状旁腺激素(PTH)及血钙均正常者79例;血钙正常,出现一过性PTH下降者13例; PTH正常,出现一过性血钙下降者4例; PTH下降及血钙同时下降并出现临床低钙血症症状者15例。术后随访6个月,出现永久性甲状旁腺功能减退者2例。结论甲状腺全切术中,运用精细化被膜解剖技术,准确辨认甲状旁腺实施原位保护并保护其血供,必要时术中行自体移植,是避免造成术后永久性甲状旁腺功能减退的有效措施。

Objective To explore the methods of identifying and protecting parathyroid glands during total thyroidectomy and to reduce the possibility of parathyroid gland injury.Methods Totally,113 cases of total thyroidectomy from January 2014 to June 2017 in the Department of Otolaryngology and Head and Neck Surgery of Dalian Friendship Hospital were retrospectively analyzed.During the operation,parathyroid glands were carefully identified and dissected in detail to preserve parathyroid glands as much as possible in situ.If blood supply was found to be poor or mistakenly removed during the operation,the belt muscle or sternocleidomastoid muscle were implanted.Results PTH and serum calcium levels were normal in 79 cases.Thirteen cases had normal serum calcium and transient PTH decline.Four cases had normal PTH and transient hypocalcemia.Fifteen cases had simultaneous PTH and serum calcium decline with clinical hypocalcemia.After 6 months of follow-up,there were 2 cases of permanent hypoparathyroidism.Conclusion During the total thyroidectomy,the precise dissection technique of tunica pellucida is used to accurately identify parathyroid glands and protect their blood supply.Autotransplantation during the operation if necessary is an effective measure to avoid permanent hypoparathyroidism after the operation.