系膜分层解剖法在全甲状腺切除术中保护上位甲状旁腺的应用价值

The clinical implication of the layer dissection for the superior parathyroid in total thyroidectomy

目的应用系膜分层解剖法行全甲状腺切除术,通过评价术中上位甲状旁腺的保护效果和术后甲状旁腺功能监测,总结系膜分层解剖法在甲状腺手术中的应用效果。方法回顾性总结2019年6月至2019年12月就诊于首都医科大学附属北京友谊医院的应用系膜分层解剖法行全甲状腺切除手术33例患者的临床资料,统计分析术中上位甲状旁腺的显露率、原位保留率及术后甲状旁腺素、钙离子水平,并对病例进行术后随访。结果33例患者行全甲状腺切除,其中双侧中央区淋巴结清扫12例,单侧中央区淋巴结清扫21例。上位甲状旁腺显露率为93.9%(62/66),其中双侧均显露患者30例,单侧显露患者2例;上位原位保留率为96.8%(60/62)。术后发生低钙血症7例,其中5例出现指端及口周麻木,2例无症状,无抽搐症状。随访1个月,复查血钙及甲状旁腺素水平均正常,无一例永久性低钙血症发生。结论全甲状腺切除术中应用系膜分层解剖法处理甲状腺上极,能够提高上位甲状旁腺的识别和保护,提高原位保留率,减少术后低钙血症的发生率,获得良好的治疗效果。

Objective To evaluate the effect of the layer dissection in the total thyroidectomy with the recognition and retention of superior parathyroid during operation and the parathyroid function after the operation.Methods The clinical data of 33 patients who underwent total thyroidectomy with mesangial layered anatomy in Beijing Friendship Hospital affiliated to Capital Medical University from June 2019 to December 2019 were retrospectively reviewed.The exposure rate,in situ retention rate,postoperative parathyroid hormone and calcium ion levels were statistically analyzed,and the patients were followed up after operation.Results Total thyroidectomy was performed in 33 patients,including bilateral central lymph node dissection in 12 cases and unilateral central lymph node dissection in 21 cases.The exposure rate of superior parathyroid gland was 93.9%(62/66),including 30 patients with bilateral exposure and 2 patients with unilateral exposure.The in situ retention rate was 96.8%(60/62).Seven cases of hypocalcemia occurred after operation,including numbness of fingertip and/or perioral numbness in 5 cases,asymptomatic in 2 cases.Follow up for one month,the blood calcium and parathyroid hormone levels were normal,and there was no permanent hypocalcemia.Conclusion The application of the layer dissection in the treatment of the superior parathyroid during total thyroidectomy can improve the recognition and protection of the superior parathyroid gland,improve the in situ retention rate,reduce the incidence of postoperative hypocalcemia,and obtain a good therapeutic effect.