甲状腺手术中甲状腺上下动静脉处理方法与术后甲状旁腺功能低下的临床分析  

Clinical analysis of relationship between different ways of dealing with the vessels of thyroid in the thyroidectomy and hypoparathyroidism in postoperation

作　　者：蔡成福[1] 赵德安[1] 孔德全[2] 高兴强[1] 刘存山[1] 

机构地区：[1]福建医科大学附属厦门第一医院耳鼻咽喉头颈外科,361003 [2]福建医科大学附属厦门第一医院急诊外科,361003

出　　处：《中国临床实用医学》2009年第3期16-18,共3页China Clinical Practical Medicine

摘　　要：目的探讨甲状腺手术中甲状腺上下动静脉处理方法对术后甲状旁腺功能的影响。方法回顾分析2002年1月至2007年1月我科收治的795例甲状腺手术病例的临床资料及术后随访情况。结果单侧甲状腺部分切除390例，其中完全断扎甲状腺上下动静脉血管束207例，术后出现暂时性甲旁低2例（2／207），永久性甲旁低0例（0／207）；先结扎甲状腺上下动静脉血管束，缝合残留腺体及被膜后松开结扎线者183例，术后出现暂时性甲旁低1例（1／183），永久性甲旁低0例（0／183）。双侧甲状腺部分切除405例，其中完全断扎甲状腺上下动静脉血管束201例，术后暂时性甲旁低28例（28／201），永久性甲旁低2例（2／201）；先结扎甲状腺上下动静脉血管束，缝合残留腺体及被膜后松开结扎线者204例，术后出现暂时性甲旁低4例（4／204），永久性甲旁低0例（0／204）。单侧甲状腺部分切除术术中两种处理血管的方法对术后甲状旁腺功能的影响差异无统计学意义（P〉0．05）；双侧甲状腺部分切除术两种处理血管的方法对术后甲状旁腺功能的影响具有显著差异（P〈0．05）。结论双侧甲状腺部分切除术中先结扎后松开甲状腺上下动静脉较完全断扎上下动静脉对保证甲状旁腺的血供、防止及降低甲状腺术后甲状旁腺功能低下有显著意义。Objective To investigate the influence on parathyroid gland function in different ways of dealing with the vessels of thyroid in the thyroidectomy. Methods Analysing 795 cases with single partial thyroidectomy or bilateral thyroidectomy from January ,2002 to January ,2007 and the post-surgical visits. Results Of all 390 cases with single partial thyroidectomy, thyroid veins and arterias were completely cut off in 207 cases, as a result 2 cases with temporary hypoparathyroidism, while no permanent hypoparathyroidism appeared. Among 183 cases with remaining thyroid veins and arterias, there was only 1 case with temporary hypoparathyroidism, but no permanent hypoparathyroidism. Of the 405 cases with bilateral partial thyroidectomy, thyroid veins and arterias were completely cut off in 201 cases, 28 cases of which were with temporary hypoparathyroidism, meanwhile 2 cases with permanent hypoparathyroidism. Among other 204 cases with remaining thyroid veins and arterias ,4 cases were with temporary hypoparathyroidism, but no permanent hypoparathyroidism. There is no statistically significance in the two ways of dealing with thyroid veins and arterias in single partial thyroidectomy（ P 〉 0. 05 ）. While the results differ significantly in these two ways in bilateral partial thyroidectomy （ P 〈 0. 05 ）. Condnsion In bilateral partial thyroidectomy, comparing with the way of completely cutting off thyroid veins and arterias, it is a safer and more effective approach to preventing hypoparathyroidism by remaining thyroid veins and arterias.

关 键 词：甲状腺部分切除术 手术方式 甲状腺动脉与静脉 甲状旁腺功能减退 

分 类 号：R653[医药卫生—外科学] R473.6[医药卫生—临床医学]