甲状旁腺原位保护技术在甲状腺全切除术中的应用  

Effect of protecting parathyroid in situ in the operation of total thyroidectomy

作　　者：吴高松[1] 马小鹏[1] 刘捷[1] 刘岩岩[1] 汪杰[1] 黄丽丽[1] 尹玉平[1] 易继林[1] 邹声泉[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院甲状腺乳腺外科, 武汉430030

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第2期120-123,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：湖北省自然科学基金（2008CDB179）;国家卫生部规划视听教材基金（09-V0-15）

摘　　要：目的评估甲状腺全切术中甲状旁腺原位保护对术后甲状旁腺功能的意义。方法同一医疗手术组连续实施的1019例甲状腺全切除术患者，术中在解剖游离甲状腺的过程中注意原位保护甲状旁腺，包括：正确辨认甲状旁腺，精确解剖甲状腺被膜，最大限度保护甲状旁腺血供，并记录保留甲状旁腺数目。检测并对比术前、术后24—48h的血清钙离子和甲状旁腺激素（PTH）水平，对术后出现低钙血症以及甲状旁腺功能低下者进行1—6个月的支持治疗及随访。结果1019例接受甲状腺全切除术的患者均原位保护至少1枚甲状旁腺。术后出现暂时性甲状旁腺功能低下者89例（8．7％），出现有症状低钙血症者42例（4．1％）；治疗及随访6个月～2年甲状旁腺激素以及血钙水平均恢复正常。原位保护甲状旁腺3和4枚的患者术后出现PTH降低者（69／999）较保护1和2枚的患者（20／20）显著减少，低钙血症症状的发生比率也显著减少（分别为25／999和17／20），差异有统计学意义（P值均〈0．01）。结论甲状旁腺的原位保护是预防术后永久性甲状旁腺功能低下的有效手段。Objective To evaluate the effect of protecting parathyroid glands in situ in the operation of total thyroidectomy by detecting parathyroid hormone after the operation. Methods In the surgical team, 1019 consecutive patients with thyroid diseases were treated with total thyroideetomy. During the operation, parathyroid glands were protected in situ with correctly identifying the parathyroid glands, precisely dissecting its envelope and protecting its blood supply. Serum calcium level and parathyroid hormone were measured before and 24 hours after operation. The patients who had symptomatic hypocalcemia or hypoparathyroidism were given supportive treatment and followed-up. Results At least one of the parathyroid glands was preserved and remained in situ in all cases. Eighty-nine cases （8. 7% ） had decreased parathyroid hormone levels and 42 cases （4.1% ） had complicated symptomatic hypocalcemia. The symptoms of hypocalcemia in all these cases could be controlled by supportive treatment, and serum calcium level and parathyroid hormone had all recovered 1 - 6 months later. If 3 and 4 parathyroid were conserved in situ, the postoperative complication rate was significantly lower than those with 1 and 2 parathyroid conserved（ decreased PTH 69/999 vs 20/20, symptoms of hypocalcemia 25/999 vs 17/20, all P 〈 0.01 ）. Conclusion The techniques to protect parathyroid glands in situ are effective measure to prevent the postoperative hypoparathyroidism in total thyroidectomy.

关 键 词：甲状腺切除术 甲状旁腺 低钙血症 手术后并发症 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]