甲状旁腺显露及其功能保护的临床研究

目的探讨甲状腺术中甲状旁腺的显露、定位、保护的方法。方法回顾性研究228例甲状腺手术的术中显露、定位及保护情况。结果术中5例未找到明确的甲状旁腺；见上甲状旁腺共289枚，其中268枚（92．73％）位置恒定于甲状腺背面甲状软骨下缘水平；下甲状旁腺共359枚，位置变异较大，167枚（46．51％）位于甲状腺背面下1／3部分，108枚（30．08％）位于甲状腺侧叶最下端近甲状腺下动脉入腺体处。术后发生低钙血症23例，其中一侧叶全切除1例（为二次手术），一侧叶全切加对侧叶次全切除2例，甲状腺全切除5例，甲状腺全切加中央组颈淋巴结清扫4例，甲状腺全切加一侧颈淋巴结清扫5例，甲状腺全切加双侧颈淋巴结清扫6例，发生永久性甲状旁腺功能低下4例。结论甲状腺全切或甲状腺手术联合颈淋巴结清扫易损伤甲状旁腺，引起低钙血症。预防术后甲状旁腺功能减退的关键是术中精细解剖，尽量原位保护甲状旁腺及其血供，必要时行甲状旁腺自体移植。

Clinic investigation of exposure and functional protection of parathyroid glands

Objective To investigate exposure and locating of parathyroid glands(PTGs),and its function protecting during thyroidectomy.Methods In our hospital,from January 2008 to November 2009,228 cases of patients had their PTGs located,exposed and pmtocted during thyroidectomy and postoperative hypoparathyroidism were studied retrospectively.Results There was no PTGS found in 5 cases(2.19%),289 superior PTGs were found,of which 268(92.73%)located constantly on the posterior side of the thyroid and on the level of the lower edge of the thyroid cartilage.359 inferior PTGs were found.and the locations were more variable.167(46.51%)in the thyroid gland on the back of lower 1/3 part,108(30.08%)located near the bottom of the lateral lobe close to where the inferior thyroid arteries entered the thyroid gland.Postoperative hypocalcemia occurred in 23 cases,1 cage underwent unilateral total lobectomy(for the secondary surgery).2 cases underwent unilateral total lobectomy plus contralateral subtotal lobectomy,5 cases underwent total thyroidectomy.4 cases underwent total thyroidectomy plus centralcompartment neck lymph node dissection,5 cases underwent total thyroidectomy plus unilateral neck lymph node dissection,6 patients underwent total thyroidectomy plus bilateral neck lymph node dissection,4 cases suffered permanent hypoparathyroidism.Conclusions In total thyroidoctomy or thyroid surgery combined with neck lymph node dissection,parathyroid glands are easy to be damaged and resulted in hypocalcemia.To prevent postoperative hypoparathyroidism,the PTGs should be protected in situ through meticulous dissection without jeopardizing their blood supplies,or parathyroid autotransplantation could be performed to avoid permnant hypoparathyroidism.