甲状腺全切除术中保护甲状旁腺功能研究分析

目的总结甲状腺全切除术中甲状旁腺功能的保护方法。方法回顾性分析2009年10月至2014年6月收治的42例行甲状腺全切除术患者的临床资料,比较手术前后血清甲状旁腺激素(PTH)、血钙水平变化。结果术后PTH暂时低下者19例(45.2%),低钙血症者9例(21.4%),术后30 d复查血清PTH及血钙均恢复正常,未见永久性甲状旁腺功能低下的病例。术后第1、3、5天,血清PTH较术前明显降低(P0.05),而术后30 d,血清PTH与术前无显著性差异(P0.05)。血钙水平除了术后第1天、第3天低于术前(P0.05),其余时间点与术前均无显著性差异(P0.05)。结论甲状腺全切除术中加强对甲状旁腺解剖位置的辨别、血供的保护,可有效减少术后甲状旁腺的损伤,避免严重并发症的发生。     

策略性甲状旁腺自体移植在甲状腺乳头状癌再次中央区淋巴结清扫中的应用

目的探讨策略性甲状旁腺自体移植是否能有效减少甲状腺乳头状癌(PTC)再次中央区淋巴结清扫术后甲状旁腺功能低下的发生率。方法回顾性分析2009年1月至2015年10月期间在四川大学华西医院甲状腺外科因PTC复发(淋巴结转移)再次行单侧或双侧中央区淋巴结清扫(包括颈侧区清扫)患者的临床资料,根据初次手术是否行策略性甲状旁腺自体移植分为移植组和未移植组。统计及比较2组患者一般情况、术前血Ca2+及甲状旁腺激素水平、首次手术方式、再次手术前是否存在声带麻痹、再次手术方式和术后并发症。结果 74例PTC再次手术患者纳入研究,其中移植组35例,未移植组39例。术后1 d血Ca2+及甲状旁腺激素水平移植组明显高于未移植组(P0.05);移植组2例患者新出现喉返神经损伤,未移植组5例新出现喉返神经损伤(5.7%比12.8%,P0.05);移植组和未移植组分别有4例和12例出现暂时性甲状旁腺功能低下,1例和4例出现永久性甲状旁腺功能低下,2组甲状旁腺功能低下发生率差异有统计学意义(14.3%比41.0%,P0.05)。术后病理学检查结果提示2组中央区淋巴结清扫数目分别为(2.1±1.3)枚和(1.4±0.7枚),其差异有统计学意义(P0.05)。结论策略性甲状旁腺自体移植可有效减少PTC再次中央区淋巴结清扫术后甲状旁腺功能低下的发生,从而大大提高手术安全性及彻底性。     

颈淋巴结择区清除联合~(131)I治疗cN_0甲状腺癌临床效果分析

目的 :探讨颈淋巴结择区清除联合~(131)I治疗cN_0甲状腺癌患者临床效果。方法:回顾性收集择期行手术治疗的cN_0甲状腺癌患者92例,根据手术治疗方式不同,将患者分为常规组(n=34)和联合组(n=58),常规组行甲状腺常规切除术,联合组行颈淋巴结择区清除联合~(131)I治疗;联合组又分为高剂量组(n=29)和低剂量组(n=29),于手术治疗7 d后,低剂量组治疗的累计剂量为20~30 mCiI,高剂量组治疗的累计剂量为80~100 mCiI。治疗后,分别检测各组患者血清甲状腺功能指标(TSH、FT3和FT4),以及血清Tg和TGAb水平,所有患者均随访至2016年3月31日,利用Kaplan-M eier生存分析对患者治疗后生存时间进行分析。结果:联合组首次清甲(清除残留甲状腺组织)成功率为86.2%(50/58),显著高于常规组的67.6%(23/34),差异有统计学意义(χ~2=4.506,P=0.034);联合组和常规组治疗总有效率分别为94.8%和79.4%,差异有统计学意义(P=0.022);联合组血清TSH、FT4、Tg和TGAb水平低于常规组,差异均有统计学意义(P0.05),高剂量组和低剂量组血清TSH、Tg和TGAb水平均低于常规组(P0.05),高剂量组血清TSH、FT3、FT4水平均低于低剂量组和常规组,差异均有统计学意义(P0.05);Kaplan-Meier分析显示,低剂量组和高剂量组治疗后生存时间分别为90.6个月和88.6个月,均高于常规组的70.5个月,差异有统计学意义(χ~2=7.887,P=0.019)。结论 :颈淋巴结择区清除联合~(131)I可提高cN_0甲状腺癌患者治疗效果,降低Tg水平,减少术后复发,尤其是低剂量~(131)I可有效减少对甲状腺功能的影响。     

~(131)I联合微波消融治疗复发性甲状腺癌的应用价值

探讨~(131)I联合微波消融治疗复发性甲状腺癌的应用价值及效果。选取2016年2月—2018年9月收治的40例甲状腺癌术后复发患者,根据治疗方法分为研究组、对照组各20例,研究组先用微波消融去除复发或转移病灶,然后再常规给予~(131)I治疗及左甲状腺素抑制治疗、对照组使用~(131)I治疗及左甲状腺素抑制治疗;对比两组治疗前后不同时间点的残余病灶大小变化,血清甲状腺球蛋白(Tg)、促甲状腺激素(TSH)的变化,不良反应发生率。术前,两组复发转移灶大小差异无统计学意义(P0.05);术后1周、1个月、3个月、6个月,两组复发转移灶逐渐缩小(P0.05);术后1、3、6个月,研究组复发转移灶均小于对照组(P0.05);治疗前,两组血清TSH、Tg水平差异无统计学意义(P0.05);治疗后3个月,研究组血清Tg水平低于对照组(P0.05),两组血清TSH水平差异无统计学意义(P0.05);研究组不良反应率30.00%,与对照组的10.00%比较,差异无统计学意义(P0.05)。临床治疗复发性甲状腺癌,选择~(131)I联合微波消融法,治疗安全性较高,有效降低肿瘤负荷,Tg明显降低或转阴,治疗效果较明显,具有较大意义。     

不同淋巴结清除术式对甲状腺乳头状癌患者术后PTH及血清钙的影响

探讨不同淋巴结清除术式对甲状腺乳头状癌患者术后PTH及血清钙的影响。146例甲状腺乳头状癌患者随机分为中央区清除组(n=73)和同侧改良清除组(n=73),中央区清除组患者行甲状腺一侧叶、峡部全切,同时行中央区淋巴结清除术;同侧改良清除组患者行甲状腺一侧叶、峡部全切,同时行同侧颈部淋巴结改良清除术。分别于术前(T0),术后1 d(T1)、3 d(T2)、7 d(T3)、14 d(T4)对2组患者甲状旁腺素和血清钙水平进行检测,比较2组患者甲状旁腺功能减退及低血清钙发生情况。中央区清除组患者术后各时相点PTH和血清钙水平均高于同侧改良清除组,差异均具有统计学意义(P0.05),与术前相比,2组患者T1~T4时相点PTH浓度均降低(P0.05),中央区清除组患者T1~T2时相点血清钙浓度均降低(P0.05),同侧改良清除组患者T1~T4时点血清钙浓度均降低(P0.05);中央区清除组患者甲状旁腺功能减退和低血清钙发生率分别为12.3%和9.6%,均低于同侧改良清除组,差异均具有统计学意义(P0.05)。中央区淋巴结清除术在一定程度上可以有效降低对甲状旁腺的影响,减少低血清钙的发生,效果优于同侧颈部淋巴结改良颈清除术。     

CaCO3联合阿法骨化醇对骨质疏松合并2型糖尿病患者L1-L4骨密度及血Ca、P代谢的影响

目的探讨CaCO3联合阿法骨化醇对骨质疏松(Osteoporosis,OP)合并2型糖尿病(Type 2 diabetes,T2DM)患者L_1-L_4骨密度及血Ca、P代谢的影响。方法纳入2015-2017-06于我院治疗的80例OP合并T2DM患者,数字随机法分为观察组与对照组各40例。对照组采用CaCO_3治疗,观察组在此基础上联合阿法骨化醇治疗。连续治疗3个月后检测血清Ca、P、碱性磷酸酶、甲状旁腺激素水平,测量治疗前后L_1-L_4平均骨密度以及血清I型胶原C端肽(B-CTX)水平及骨钙素水平,综合评价临床疗效。结果观察组治疗总有效率为85.00%,显著高于对照组的45.00%,差异有统计学意义(P0.05);两组治疗后血清Ca、P水平均有所升高,但差异无统计学意义(P0.05);两组治疗后碱性磷酸酶、甲状旁腺激素水平显著降低,且观察组显著低于对照组(P0.05)。治疗后观察组L_1-L_4平均骨密度、血清骨钙素水平显著高于对照组,B-CTX水平显著低于对照组,差异有统计学意义(P0.05)。结论 OP合并T2DM患者采用常规钙剂联合阿法骨化醇治疗能显著增加腰椎骨密度,降低碱性磷酸酶、甲状旁腺激素水平以调节钙磷代谢,提升临床疗效。     

腔镜辅助与常规甲状腺全切除术后131I清甲疗效的比较

目的:回顾性分析腔镜辅助甲状腺全切除术对甲状腺乳头状癌(PTC)病人接受131I清除残留甲状腺(清甲)治疗的影响,并选择与同期接受常规甲状腺全切除术且病情类似的PTC病人131I清甲资料进行比较。方法:纳入本研究的PTC病人共144例,腔镜辅助甲状腺全切除术后(腔镜组)病人66例,常规甲状腺全切除术后(常规组)病人78例,均住院接受131I清甲治疗。对治疗前超声检查、甲状腺功能指标变化及甲状腺球蛋白、治疗后的131I全身扫描等结果进行评价。采用独立样本t检验比较两组在131I清甲治疗前残留甲状腺的差异;随访时间为4～36个月。卡方检验比较两组131I清甲成功率的差异性。结果:131I清甲治疗前腔镜组及常规组残留甲状腺体积分别为(3.8±1.3)mm3和(3.3±1.0)mm3;两者比较无统计学差异(t=1.17;P=0.25)。单次131I清甲成功率腔镜组为72.7%(48/66);常规组为71.8%(56/78),两组间无统计学差异(χ2=0.015;P=0.901);结论:与常规甲状腺全切除术相比,腔镜辅助下甲状腺全切除术对后续的单次131I清甲疗效没有影响。     

甲状腺手术中甲状旁腺损伤的预防和术后低钙血症的治疗

目的探讨甲状腺术中甲状旁腺损伤的预防和术后低钙血症治疗。方法选择134例接受甲状腺手术的患者作为研究对象,探讨不同手术方式术后甲状旁腺功能低下的发生情况、治疗效果及预后。结果双侧甲状腺叶全切除及中央区淋巴清扫术患者甲状旁腺功能低下症状的总发生率显著高于实施双侧腺叶次全切除术、单侧腺叶次全切除及对侧腺叶部分切除术及单侧或双侧甲状腺叶大部分切除术的患者,差异均有统计学意义(P0.05)。实施甲状腺手术后1 d,患者血清Ca2+水平均有所下降,除单侧或双侧甲状腺叶大部分切除术外,与术前相比,差异均有统计学意义(P0.05)。术后3 d血清Ca2+水平开始回升,术后5 d时,仅有一侧腺叶全切除及对侧腺叶部分切除术以及双侧甲状腺叶全切除及中央区淋巴清扫术两种术式较术前的血清Ca2+水平差异有统计学意义(P0.05)。全部患者中共有9例发生低钙血症。结论为患者实施甲状腺手术时,应避免伤及甲状旁腺及其血供,可减少低钙血症的发生。     

血液灌流联合血液透析治疗慢性肾功能衰竭继发甲状旁腺功能亢进的临床观察

目的 观察血液灌流联合血液透析治疗慢性肾功能衰竭继发性甲状旁腺功能亢进的临床疗效.方法 选取在我院行血液透析治疗的慢性肾功能衰竭合并继发性甲状旁腺功能亢进患者60例,按随机数字表法分为血液灌流+血液透析组30例,血液透析组30例,比较透析前及连续3次治疗后两组患者血清钙、磷、甲状旁腺激素水平的变化.结果 血液灌流+血液透析组患者和血液透析组患者治疗后血磷水平与治疗前比较差异有统计学意义(P＜0.05);血液灌流+血液透析组患者治疗后血甲状旁腺激素水平与治疗前比较差异也有统计学意义(P＜0.05),血液透析组患者治疗前血甲状旁腺激素水平与治疗后比较差异无统计学差异(P＞0.05);血液灌流+血液透析组患者治疗后血磷与血液透析组患者比较差异有统计学意义(P＜0.05);两组患者经治疗后血钙与治疗前比较差异也有统计学意义(P＜0.01).结论 血液灌流联合血液透析在降低血甲状旁腺激素水平和血磷水平要优于单纯血液透析的治疗.     

吲哚菁绿荧光显像技术在甲状腺手术中对甲状旁腺血供判断的应用

目的探讨甲状腺手术中吲哚菁绿(ICG)荧光显像技术判断原位保留甲状旁腺血供的应用价值。方法前瞻性纳入2017年6月1日至2018年1月1日期间因甲状腺乳头状癌(PTC)行甲状腺全切+双侧中央区淋巴结清扫术的患者并采用计算机随机分组的方法分为研究组和对照组,研究组采用ICG荧光显像技术评估甲状旁腺的血供,而对照组采用肉眼评估甲状旁腺的血供,最终根据甲状旁腺的血供确定甲状旁腺是原位保留还是自体移植,比较2组患者术后甲状旁腺功能低下发生、住院时间、甲状旁腺激素(PTH)等情况。结果①根据纳入和排除标准,本研究共纳入60例PTC患者,研究组和对照组各30例,2组患者的基线资料比较差异无统计学意义(P0.05)。②研究组及对照组术中甲状旁腺辨认数目及其分型以及甲状旁腺自体移植数目比较差异均无统计学意义(P0.05),A型甲状旁腺(除A3型)的ICG评分较B型甲状旁腺低(0.99±0.38比1.45±0.58,t=–2.395,P0.05)。③术后住院时间研究组较对照组更短(t=–2.159,P=0.035)。④术后暂时性甲状旁腺功能低下发生率研究组低于对照组(χ~2=5.079,P=0.024),而永久性甲状旁腺功能低下发生率2组间比较差异无统计学意义(χ~2=1.000,P=0.317),仅对照组中出现1例。⑤2组术后第1天、第1个月、第3个月及第6个月的PTH、血Ca2+水平比较差异均无统计学意义(P0.05)。结论 ICG荧光显像技术可用于术中实时地判断已原位保留的甲状旁腺血供。     

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目的 探讨甲状腺癌手术后低钙血症的发生发展规律及治疗方法。方法 对65例因甲状腺癌而做甲状腺全切除或近全切除的病人进行术后随访，动态监测血清钙，磷，镁的变化。结果 65例病人均出现不同程度的低钙血症，其中无症状低钙血症发生率为81．5％，术后不需静脉补钙治疗。有症状低钙血症的发生率为18．5％，需静脉补钙治疗，1例病人发生永久性甲状旁腺功能低下。有症状低钙血症组血清钙浓度在术后第1，2，3，5天较无症状低钙血症组血清钙浓度明显降低（P＜0．05）。有症状低钙血症组血清磷浓度在术后第2，3天较无症状低钙血症组血清磷浓度明显增高（P＜0．05）。结论 （1）有症状低钙血症发生在手术后3天之内，甲状腺癌手术后3天应常规监测血钙，血磷和血镁，血钙低于1.81mmol/L，高度警惕低钙症状出现。（2）有症状低钙血症病人经及时补充钙剂后，症状迅速改善，并往往在术后7天内消失。（3）血钙的高低与甲状旁腺的保留量，甲状旁腺素的浓度似乎无必然联系。     

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Background

Hypoparathyroidism, the most common complication after thyroid surgery, leads to hypocalcaemia and significant medical problems. An RCT was undertaken to determine whether intraoperative parathyroid gland angiography with indocyanine green (ICG) could predict postoperative hypoparathyroidism, and obviate the need for systematic blood tests and oral calcium supplementation.

Methods

Between September 2014 and February 2016, patients who had at least one well perfused parathyroid gland on ICG angiography were randomized to receive standard follow‐up (measurement of calcium and parathyroid hormone (PTH) on postoperative day (POD) 1 and systematic supplementation with calcium and vitamin D; control group) or no supplementation and no blood test on POD 1 (intervention group). In all patients, calcium and PTH levels were measured 10–15 days after thyroidectomy. The primary endpoint was hypocalcaemia on POD 10–15.

Results

A total of 196 patients underwent ICG angiography during thyroid surgery, of whom 146 had at least one well perfused parathyroid gland on ICG angiography and were randomized. None of these patients presented with hypoparathyroidism, including those who did not receive calcium supplementation. The intervention group was statistically non‐inferior to the control group (exact 95 per cent c.i. of the difference in proportion of patients with hypocalcaemia –0·053 to 0·053; P = 0·012). Eleven of the 50 excluded patients, in whom no well perfused parathyroid gland could be identified by angiography, presented with hypoparathyroidism on POD 1, and six on POD 10–15, which was significantly different from the findings in randomized patients (P = 0·007).

Conclusion

ICG angiography reliably predicts the vascularization of the parathyroid glands and obviates the need for postoperative measurement of calcium and PTH, and supplementation with calcium in patients with at least one well perfused parathyroid gland. Registration number: NCT02249780 ( http://www.clinicaltrials.gov ).     

Focus超声刀在甲状腺手术中甲状旁腺的功能保护及对术后血钙水平的影响

目的探讨Focus超声刀在甲状腺手术中的应用及其对甲状旁腺的功能保护作用,以及围手术期患者血钙水平的变化。方法选取本院2010年5月至2011年5月实施的甲状腺手术226例,采用传统手术方式,设为对照组;选取2011年6月至2012年6月实施的甲状腺手术250例,应用Focus超声刀实施手术,设为观察组。比较两组患者的手术效果与效率,术前、术后3天血清甲状旁腺素、血钙及血磷水平,观察甲状旁腺功能损伤患者治疗及随访结果。结果两组患者手术过程均比较顺利,无术中及住院期间死亡病例,术后病理诊断均与临床诊断一致;观察组患者手术时间、术中出血量、术后引流量、平均住院时间均少于（或短于）对照组（P〈0．01或P〈O．05）;观察组低钙血症、血钙下降的发生率均低于对照组（P〈0．01或P〈0．05）。术前两组患者血清甲状旁腺素、血钙、血磷比较,差异均无统计学意义（P〉0．05）;术后,对照组血清甲状旁腺素、血钙水平降低,血磷水平升高（P〈0．01或P〈0．05）,表明对照组患者甲状旁腺功能损伤;观察组患者手术前后甲状旁腺功能比较稳定。术后3月内,所有甲状旁腺功能损伤患者均恢复至正常范围,无永久性甲状旁腺功能减退的发生。结论Focus超声刀在甲状腺手术中对甲状旁腺具有较好的保护作用,术中组织分离、止血效果确切,损伤较小．术后患者血清甲状旁腺功能指标稳定,恢复较快,是目前比较优化的一种手术措施。     

甲状腺切除手术中暴露并保护甲状旁腺的必要性

【摘要】 目的 探讨甲状腺切除手术中暴露并保护甲状旁腺的必要性。方法 将164例因结节性甲状腺肿和甲状腺癌接受手术治疗的患者根据已完成手术情况分为甲状旁腺暴露组和非暴露组两组。非暴露组76例患者保留甲状腺后被膜,未寻找甲状旁腺;暴露组88例患者寻找并保护甲状旁腺,尽量保证甲状旁腺的血供及完整性。术后进行动态监测血清钙变化,观察甲状旁腺的功能情况。结果 在术中寻找并保护甲状旁腺的观察组中,术后甲状旁腺功能低下的发生率较未寻找甲状旁腺的对照组患者明显降低,两组比较差异有统计学意义(P<0.05)。结论 在甲状腺切除手术中,寻找并保护甲状旁腺,可以有效的降低术后甲状旁腺功能低下的发生率。     

Latent hypoparathyroidism in patients with autotransplanted parathyroid glands

Eighteen patients had undergone radical surgery for thyroid carcinoma. In all of them four parathyroid glands had been verified by frozen-section biopsy and removed. Thereafter two, three or four glands were autotransplanted into muscle tissue. At least 1 year after the operation the patients underwent a calcium deprivation test. Before the test they all had normal serum calcium values without treatment. During the test seven patients remained normocalcemic, seven became hypocalcemic, and four had occasional low serum calcium values. After the test all were normocalcemic again. Patients with only autotransplanted parathyroid glands left after surgery should be tested for latent hypoparathyroidism.     

甲状腺不同手术方式对甲状旁腺功能的影响

目的:探讨甲状腺不同手术方式术后甲状旁腺素(PTH)、血钙的变化,总结预防甲状腺术后甲状旁腺功能减退发生的方法及并发症的处理。方法:检测2012年1—5月191例甲状腺手术患者术前及术后血清PTH、血钙,比较术前、术后的变化,并按照手术范围分7组,比较各组之间术后PTH、血钙的变化。结果:各组术后较术前比较,血钙、血PTH均明显下降(P0.05)。同组术后1 d与4 d血PTH、血钙之间比较,差异无统计学意义(P0.05)。各组低血PTH、症状性低钙血症的发生率以及术后PTH下降幅度的比较:全甲状腺切除+双侧颈中央区淋巴清除组、全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除组甲状腺双叶切除组甲状腺单叶切除组,其差异有统计学意义(P0.05﹚,而在全甲状腺切除,以及同样范围的颈中央区淋巴清除的基础上,是否行改良颈清,对于术后低PTH血症及症状性低钙血症的发生率以及PTH下降的幅度,差异无统计学意义(P0.05﹚。低血钙的发生率比较:甲状腺单侧腺叶切除与其他6种手术方式比较、甲状腺双侧腺叶切除与全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除比较,差异有统计学意义(P0.05﹚。结论:各种甲状腺术式对甲状旁腺功能均有不同程度的影响,手术范围越大,术后并发甲状旁腺功能减退的可能性越大。预防术后甲状旁腺功能减退的根本,就在于术中甲状旁腺的保护。     

Autotransplantation of at least one parathyroid gland during thyroidectomy in benign thyroid disease minimizes the risk of permanent hypoparathyroidism

OBJECTIVE:Permanent hypoparathyroidism is a distressing complication of thyroid surgery. The reported incidence varies between 0.4 and 13.8 % and is directly correlated to the extent of thyroidectomy. The aim of this retrospective study was to analyze whether simultaneous autotransplantation of at least one parathyroid gland during total thyroidectomy for benign thyroid disease could reduce the risk of permanent hypoparathyroidism. METHODS: Since 01/1999 all thyroid operations are prospectively recorded. Beside daily postoperative measurement of serum calcium level, iPTH is routinely determined on the third post op day. Patients with complications are followed closely. Postoperative hypoparathyroidism persisting for more than 6 months is defined permanent. RESULTS: Between 01/1999 and 02/2001 146 total thyroidectomies for benign thyroid disease have been performed (81 pat. with Graves disease, 62 with nodular goiter, 3 with thyroiditis de Quervain/Hashimoto). In 37 pat. (25 %) at least one parathyroid gland was simultaneously autotransplanted into the ipsilateral sternocleidomastoid muscle. Group I (no parathyroid autotransplantation, n = 109) and group II (parathyroid autotransplantation, n = 37) were comparable concerning patient age, thyroid disease and lowest post op calcium level (2.07 versus 2.05 mmol/l). The incidence of postoperative symptomatic hypocalcemia (14.7 % versus 21.6 %) and temporary hypoparathyroidism (15.6 % versus 18.9 %) was higher in group II patients (n. s.). Conversely, permanent hypoparathyroidism occurred exclusively in group I patients (2.75 %), patients with parathyroid autotransplantation (group II) did not develop this complication. CONCLUSIONS: Simultaneous autotransplantation of at least one parathyroid gland during total thyroidectomy for benign thyroid disease seems to minimize the risk of permanent hypoparathyroidism. The potential of routine autotransplantation in this setting has to be evaluated. The incidence of postoperative temporary hypocalcemia may be elevated with this policy.     

Parathyroid autotransplantation with total thyroidectomy for thyroid carcinoma: long-term follow-up of grafted parathyroid function.

BACKGROUND: Permanent hypoparathyroidism is a major complication of thyroidectomy. Autotransplantation of parathyroid glands has been attempted to prevent this complication. However, no direct data have been available to assess grafted parathyroid function after long-term follow-up in terms of the serum intact parathyroid hormone (PTH) concentration. METHODS: Eighty-four consecutive patients with differentiated thyroid carcinoma who underwent total thyroidectomy and bilateral modified neck dissection from 1992 to 1996 were enrolled. They concomitantly underwent total parathyroidectomy and autotransplantation of all parathyroid glands to the pectoralis major muscle. The serum intact PTH concentration was periodically measured as an index of grafted parathyroid function. RESULTS: The mean follow-up was 34 months. In all autotransplanted patients serum intact PTH concentrations fell below detectable limits immediately after surgery. They were restored to the normal range within 1 month postoperatively and were maintained during observation in 80 (95%) of 84 patients. Seventy-eight of 80 patients with normal intact PTH values were normocalcemic without any treatment and the remainder were normocalcemic with 1 microgram of 1 alpha-vitamin D3. Four hypoparathyroid patients were normocalcemic with 2 micrograms of 1 alpha-vitamin D3. The postoperative average serum intact PTH concentration of patients having more than 2 autotransplanted parathyroid glands was almost equal to that of patients with preservation of the parathyroid glands in situ. The incidence of permanent hypoparathyroidism was inversely correlated with the number of autotransplanted parathyroid glands. CONCLUSIONS: The recovery patterns of the intact PTH concentration indicate that the glands were grafted successfully and functioned for a long period. This feasible method of parathyroid autotransplantation bears comparison with the previous reports in terms of the incidence of permanent postoperative hypoparathyroidism, and it can be performed simply and is reproducible.     

甲状腺癌根治术致甲状旁腺功能减退的危险因素及预防

目的:探讨甲状腺癌根治术中可能导致甲状旁腺功能减退的危险因素及预防措施。方法:回顾性分析首都医科大学附属北京同仁医院普通外科2014年全年由同一外科医师实施的75例甲状腺癌手术的临床资料。结果:全组术后发生甲状旁腺功能减退20例(26.67%),其中暂时性甲状旁腺功能减退19例(25.33%),永久性甲状旁腺功能减退1例(1.33%)。甲状腺全切术患者甲状旁腺功能减退发生率明显高于甲状腺近全切除术患者(46.88%vs.11.63%,P0.05);行VI区淋巴结清扫患者甲状旁腺功能减退发生率明显高于未行VI区淋巴结清扫患者(45.71%vs.10.00%,P0.05);同时行自体甲状旁腺移植术患者甲状旁腺功能减退发生率高于未行甲状旁腺移植患者,但差异无统计学意义(50.00%vs.22.22%,P0.05)。结论:甲状腺全切和Ⅵ区淋巴结清扫是导致甲状旁腺功能减退的危险因素。术中精细解剖甲状腺后被膜,尤其是尽可能保留下甲状旁腺血运,术后应用预防性药物可能有助于甲状旁腺功能的保护。     

近红外自体荧光显像技术在甲状腺肿瘤手术中辅助识别甲状旁腺有效性分析

目的 探讨分析近红外自体荧光显像（NIRAF）技术在甲状腺肿瘤手术中辅助识别甲状旁腺的有效性。方法 回顾性分析中国人民解放军总医院第一医学中心2020-04-01-2020-10-20应用NIRAF技术实施甲状腺肿瘤手术的53例病例临床资料,设为辅助组。同时对同中心同期完成的甲状腺肿瘤手术病例资料经过倾向性评分匹配后选取53例作为对照组,与辅助组进行匹配。对比分析两组术后甲状旁腺保护情况。结果 辅助组术中识别确切甲状旁腺数目多于对照组,差异有统计学意义（P<0.05）。辅助组术后甲状旁腺激素（PTH）水平和血清钙离子浓度高于对照组,差异有统计学意义（P<0.05）。行双侧甲状腺切除的病例中,辅助组术后PTH水平和血清钙离子浓度高于对照组,差异有统计学意义（P<0.05）。通过甲状腺切除后标本观察证实,补救2枚遗漏甲状旁腺,予以重新种植。结论 NIRAF技术能够有效辅助识别甲状旁腺,进而提示外科医生对其有效保护,起到功能保护的作用,进一步提高了甲状腺手术的安全性。