精细化被膜解剖法在甲状腺全切手术中的应用

目的探讨精细化被膜解剖法在甲状腺全切手术中的应用。方法回顾性分析四川省肿瘤医院头颈外科2012年1月至12月118例应用精细化被膜解剖法行甲状腺全切术患者的临床资料。结果所有病例术中均发现并保留l～4枚甲状旁腺。其中16例未发现明确的下旁腺；术中发现上甲状旁腺197枚，其中42枚由甲状腺上动脉分支供血，131枚由甲状腺下动脉上行支供血；下甲状旁腺163枚，明确的下动脉分支血管供血的136枚。术后有62例（52.5%）甲状腺激素（PTH）值低于正常值（一过性甲状旁腺功能低下），其中56例于术后第7天恢复正常，其余6例于术后2～4周恢复正常；23例有暂时性低钙血症症状的患者，术后4 d～1月都恢复正常，无永久性低钙血症。所有病例术中均解剖并显露双侧喉返神经，除术前喉返神经受侵或损伤的患者，其余患者均未发生永久性喉返神经损伤。结论采用精细化被膜解剖法行甲状腺全切除术，能较好地原位保留甲状旁腺及其血供、避免喉返神经损伤的发生，减少甲状腺全切除术的并发症。

Application of meticulous capsular dissection technique in total thyroidectomy

Objective To assess the application of meticulous capsular dissection technique in total thyroidectomy. Methods The retrospective analysis of clinical data of 118 patients who received meticulous capsular dissection in Sichuan Cancer Hospital from Jan. 2012 to Dec. 2012 was carried out. Results All patients were kept at least one parathyroid gland during operation successfully. One hundred and ninty-seven upper parathyroid glands were found. Among them, the blood supply of 42 upper parathyroid glands came from superior thyroid artery. The other 131 upper parathyroid glands were supplied by inferior thyroid artery. In addition, the lower parathyroid glands were not found in 16 patients. But the other 163 lower parathyroid glands were found during meticulous capsular dissection, 136 of which were supplied by inferior thyroid artery. After this operation, the PTH value was significantly decreased in 62 patients （52.5%）. Fifty-six cases recovered the PTH value to normal levels seven days after operation;the other six patients recovered two to four weeks after operation. 23 patients had hypocalcemia after the operation. However, all of them recovered the normal blood calcium four days to 1 month after operation. In this group, all patients received the bilateral dissection of recurrent laryngeal nerve. No patients had permanent recurrent laryngeal nerve damage except the patients who suffered from nerve invasion or damage before operation. Conclusion Total thyroidectomy through application of meticulous capsular dissection technique can keep the parathyroid glands and its blood supply well, avoid the damage of recurrent laryngeal nerve and decrease the risk of complication after total thyroidectomy.