甲状腺手术中甲状旁腺自体移植效果评价  

Evaluation of the function of autotransplanted parathyroid tissues

作　　者：徐国辉[1] 张乃嵩[1] 宋韫韬[1] 于文斌[1] 魏炜[1] 孙俊勇[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所头颈外科恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第8期668-671,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的评估甲状腺手术中自体移植甲状旁腺的功能，为甲状旁腺自体移植的有效性提供理论根据。方法检测120例甲状旁腺正常志愿者双侧肘部头静脉血清中甲状旁腺素，将其作为正常对照，检测34例在甲状腺手术中由于误切或因缺血等原因无法保留的甲状旁腺进行自体移植的患者作为实验组，将甲状旁腺移植于患者的非正力侧前臂肱桡肌肌腹内，分别于手术当日、术后3d、7d及术后2个月检测移植甲状旁腺在双侧肘部头静脉血清中的甲状旁腺素质量浓度，根据移植后其差值，判定移植甲状旁腺是否成活并具有分泌功能。结果正常对照组120例志愿者双侧肘部头静脉血清甲状旁腺素差值的绝对值平均（x±s）为（1．19±0．98）ng/L，极大差值为4．52ng／L，本研究以极大差值的2倍即9．04ng／L作为评估实验组受试者甲状旁腺自体移植有效的标准。实验组34例患者术后2个月甲状旁腺移植有效例数为26例，有效率为76．5％（26／34）。结论大多数自体移植的甲状旁腺具有分泌功能，因此在甲状腺手术中对已经游离或严重缺血的甲状旁腺进行自体移植是保留甲状旁腺功能的有效方法。Objective To evaluate the function autotransplanted parathyroid tissues in thyroid surgery. Methods The control group comprised 120 volunteers with normal parathyroid glands in whom serum parathyroid hormone （PTH） levels in blood samples taken from the bilateral elbow head veins. The experimental group comprised 34 patients in whom the parathyroid glands, which were mistakenly cut or could not be preserved during thyroid surgery because of ischemia, were fragmented and autografted into the brachioradialis muscle of the nondominant forearm. On the day of surgery and at 3 days, 7 days, and 2 months postoperatively, contrast imaging and detection of serum PTH levels were performed to evaluate the function of the transplanted parathyroid tissues. Results In the control group, the mean value of the difference between the bilateral brachiocephalic vein PTH levels was （ 1. 19 ± 0. 98 ） ng/L （ maximum 4.52 ng/L）. In this study, twice the maximum value（9.04 ng/L） was taken as the effective standard. Based on the 9.04 ng/L effective value, the effective number was 26 patients and the effective rate was 76. 5% at 2 months postoperatively in the 34 patients of the experimental group. Conclusions The autotransplanted parathyroid tissues showed their dunctions in most patients, therefore, parathyroid gland autotransplantation is an effective method of preserving function of parathyroid glands that are free or severely ischemic in thyroid surgery.

关 键 词：甲状旁腺 移植 自体 甲状腺切除术 

分 类 号：R653[医药卫生—外科学]