摘要
目的在甲状腺手术中认识甲状旁腺的局部解剖及甲状腺手术切除范围和甲状旁腺功能减退的关系，探讨术后甲状旁腺功能减退的原因及预防治疗措施。方法回顾2582例甲状腺手术患者的临床资料并术后随访。结果其中对721例双侧甲状腺侧叶全切者行术中探察，发现甲状腺病理状态下甲状旁腺的局部解剖位置及数量变异大，探察到的每种情况术后暂时性甲状旁腺功能减退发生率各不相同，其中上下甲状旁腺双侧均不明显组永久性甲状旁腺功能减退发生1例。2453例手术中行甲状腺部分切除、单侧叶次全切除、单侧叶全切除、双侧叶全切除、双侧叶全切及颈淋巴结清扫者（即甲状腺癌根治）暂时性甲状旁腺功能减退发生率依次增高，其中以双侧叶次全切除暂时性甲状旁腺功能减退发生率最高。且又因甲状腺疾病病种各不相同，甲状旁腺功能减退发生率亦各不相同。结论术后甲状旁腺功能减退的发生与手术操作、甲状旁腺的局部解剖及其变异、甲状腺手术切除范围、巨大甲状腺及其内巨大包块对双侧甲状腺后被膜深面组织的压迫，甲状腺疾病病种不同而手术难度各异等皆有关系。
Objective To study the anatomy of parathyroid gland and the relation of hypoparathyroidism with the mode of surgery in thyroidectomies, and to investigate the causes of postoperative hypoparathyroidism and its prevention and treatment. Methods We retrospectively reviewed the clinical and follow-up data of 2582 thyroidectomy patients. Results From the investigation of 721 double total lobectomy, we found that under the pathologic state of thyroid, the mutation about the anatomical position and quantity of the parathyroid was obvious, the incidence rate of postoperative temporality hypoparathyroidism was different in each exploration result and there was one permant hypoparathyroidism in those whose upper and inferior parathyroid glands were not clear. Among 2453 thyroidectomy the incidence rate of temporality hypoparathyroidism for partial lobectomy, unilateral subtotal lobectomy, unilateral total lobectomy , bilateral total lobectomy and bi- lateral total lobectomy plus cervical lymphadenectomy was increased in that order, and the highest incidence date was found in bilateral subotal lobectomy. As the different category of the thyroid diseas, the incidence rate of hypoparathyroidism was also different. Conclusions The occurrence of postoperative hypoparathyroidism maybe relate with operative procedure, the anatomy of parathyroid gland and its mutation, the mode of surgery, the compression from the tremendous thyroid or its node on thyriod metacaps tissue ,the different category of the thyroid disease, especially the difficulty of the operation.
出处
《国际外科学杂志》
2008年第1期8-12,共5页
International Journal of Surgery
关键词
甲状腺切除术
甲状旁腺
手术并发症
thyroidectomy
parathyroid gland
operative complications
