显微镜对甲状腺全切术甲状旁腺的原位保护作用  

In situ protection of parathyroid gland during total thyroidectomy under microscope

作　　者：路承[1] 杨衬 刘攀[1] 刘良发[1] LU Cheng;YANG Chen;LIU Pan(Department of Otolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉头颈外科,北京100050

出　　处：《临床和实验医学杂志》2020年第22期2427-2431,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市医院管理局消化内科学科协同发展中心消化专项重点项目子课题(编号:XXZ0604);中国科学院科研仪器设备研制项目(编号:YJKYYQ20180039)。

摘　　要：目的探讨显微镜在甲状腺全切术中对甲状旁腺的保护作用,探讨甲状旁腺原位保护的方法。方法前瞻性选取88例行甲状腺全切除术的甲状腺乳头状癌患者,随机分别在显微镜或肉眼下行甲状腺全切术并行双侧中央区淋巴清扫术,设定观察组和对照组,每组各44例。术中均解剖暴露甲状旁腺,采用显微镜或肉眼下辨认甲状旁腺及其供血血管并予以美兰标记保护。记录术中甲状旁腺原位保护及误切情况;记录术前、术后24 h、术后1周、术后1个月的甲状旁腺素及血钙水平,比较2组患者低钙血症及甲状旁腺功能减退发生情况。结果观察组术中甲状旁腺完全暴露率明显高于对照组(93.2%vs.68.2%),差异有统计学意义(P<0.05)。观察组误切率显著低于对照组(2.3%vs.13.6%),差异有统计学意义(P<0.05)。2组患者的术前血浆甲状旁腺素(PTH)和血钙水平比较,差异无统计学意义(P>0.05),而术后24 h[(2.81±1.44)pmol/mL vs.(2.33±1.59)pmol/mL;(2.08±0.16)mmol/L vs.(1.95±0.31 mmol/L)]、术后1周[(3.01±1.65)pmol/mL vs.(2.51±1.79)pmol/mL;(2.13±0.11)mmol/L vs.(2.01±0.24)mmol/L]、术后1个月[(4.60±1.82)pmol/mL vs.(4.11±1.96)pmol/mL;(2.28±0.22)mmol/L vs.(2.17±0.19)mmol/L]观察组血浆PTH和血钙水平均明显高于对照组,差异有统计学意义(P<0.05)。观察组患者低钙血症发生率显著低于对照组(4.5%vs.31.8%),差异有统计学意义(P<0.05)。观察组中术后24 h、术后1周、术后1个月的甲状旁腺功能减退的发生率也明显低于对照组(13.6%vs.34.1%、2.3%vs.13.6%、0vs.2.3%),差异有统计学意义(P<0.05)。结论显微镜下甲状腺全切术中能够很好地辨认和原位保护甲状旁腺及其供血血管,避免甲状旁腺及其血供的损伤,有效预防医源性永久性甲状旁腺功能低下的发生,具有临床应用价值。Objective To explore the protective effect of microscope on parathyroid gland during total thyroidectomy and the method of protecting parathyroid gland in situ.Methods 88 patients with papillary thyroid carcinoma who underwent total thyroidectomy were randomly selected to undergo total thyroidectomy under microscope or naked eye and to undergo bilateral central lymphatic dissection.The observation group(microscope group)and the control group(naked eye group)were set with 44 patients in each group.All the parathyroid glands were dissected and exposed during the operation.The parathyroid glands and their supplying vessels were identified by microscope or naked eye and protected by meilan label.The protection and misoperation of parathyroid glands in situ were recorded.The symptoms of hypocalcemia and hypothyroidism were observed by recording the data of parathyroid hormone and blood calcium 24 hours,1 week and 1 month after the operation.Results The rate of complete parathyroid exposure in the observation group was significantly higher than that in the control group(93.2%vs.68.2%),and the difference was statistically significant(P<0.05).The false cut rate in the observation group was significantly lower than that in the control group(2.3%vs.13.6%),and the difference was statistically significant(P<0.05).The preoperative plasma PTH and blood calcium levels of the two groups were not statistically different(P>0.05).However,24 hours after operation[(2.81±1.44)pmol/mL vs.(2.33±1.59)pmol/mL;(2.08±0.16)mmol/L vs.(1.95±0.31 mmol/L)],1 week after operation[(3.01±1.65)pmol/mL vs.(2.51±1.79)pmol/mL;(2.13±0.11)mmol/L vs.(2.01±0.24)mmol/L,],1 month after operation[(4.60±1.82)pmol/mL vs.(4.11±1.96)pmol/mL;(2.28±0.22)mmol/L vs.(2.17±0.19)mmol/L]the plasma PTH and blood calcium levels of the observation group were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).The incidence of hypocalcemia in the observation group was significantly lower than that in the c

关 键 词：甲状腺全切术 显微镜 甲状旁腺功能减退 低钙血症 甲状腺肿瘤 

分 类 号：R653[医药卫生—外科学]