达芬奇机器人甲状腺手术中甲状旁腺的损伤因素及保护

目的分析达芬奇机器人甲状腺手术中甲状旁腺损伤的相关因素，探讨甲状旁腺保护的方法，避免永久性甲状旁腺功能减退的发生。 方法回顾性分析2014年1月至2016年5月在济南军区总医院甲状腺乳腺外科行达芬奇机器人甲状腺手术的190例患者的临床资料，统计术后患者出现低甲状旁腺激素(PTH)及低血钙的发生率，分析术后发生甲状旁腺功能减退的相关因素，探讨术中如何保护甲状旁腺及其功能。 结果患者术后暂时性低PTH的发生率为20.53%(39/190)，暂时性低血钙的发生率为23.68%(45/190)，术后随访无永久性甲状旁腺功能减退发生。甲状腺全切术后低PTH、低血钙的发生率高于腺叶 ＋ 峡部切除术者(χ²＝14.789，11.604；P＝0.000，0.001)。行中央区淋巴结清扫的患者术后低PTH、低血钙的发生率高于未清扫者(χ²＝11.200，17.771；P＝0.001，0.000)。甲状旁腺原位保留者术后低PTH、低血钙的发生率低于切除后自体移植者(χ²＝5.536，4.851，6.140，5.453；P＝0.019，0.028，0.013，0.020)。 结论在达芬奇机器人甲状腺手术中，甲状腺全切除、中央区淋巴结清扫、甲状旁腺切除后自体移植是造成患者术后暂时性甲状旁腺功能减退的重要影响因素。在达芬奇机器人手术系统下，准确识别甲状旁腺，精细化手术操作，原位保护甲状旁腺及血供，是预防永久性甲状旁腺功能减退的有效方法。

Risk facrors and protection of parathyroid in Da Vinci robotic thyroidectomy

ObjectiveTo analyze the risk factors responsible for hypoparathyroidism and investigate the technique for preserving parathyroid in Da Vinci robotic thyroidectomy, avoiding the permanent hypoparathyroidism. MethodsTotally 190 cases of patients performed da vinci robotic thyroidectomy were reviewed retrospectively from Jan. 2014 to May. 2016 in the General Hospital of Jinan Military Command of PLA.The incidence and relevant factors of hypoparathyroidism and hypocalcemia were evaluated, and ways to protect the parathyroid glands were assessed. ResultsIn all the patients, 39 patients were hypoparathyroidism with the incidence rate of 20.53%, and 45 cases were transient hypocalcemia with the incidence rate of 23.68%. Permanent hypoparathyroidism did not happen. In robotic thyroidectomy, compared with unilateral lobectomy, total thyroidectomy resulted in higher incidence of hypoparathyroidism and hypocalcemia (χ²=14.789, 11.604; P=0.000, 0.001). The comparison between patients receiving central compartment lymph node dissection or not had the same result (χ²=11.200, 17.771; P=0.001, 0.000). Compared with parathyroid left in situ, parathyroid resection with parathyroid autotransplantation more likely to lead to hypoparathyroidism (χ²=5.536, 4.851, 6.140, 5.453; P=0.019, 0.028, 0.013, 0.020). ConclusionsIn da vinci robotic thyroidectomy, total thyroidectomy, central compartment lymph node dissection and parathyroid excision with parathyroid autotransplantation are associated with transient hypoparathyroidism significantly. In da vinci robotic thyroidectomy, it should be paid more attention to accurate identification of parathyroid, precise action in operation and protection of parathyroid glands and its blood supply to prevent postoperative permanent hypoparathyroidism.