摘要
目的：甲状腺全切除术的并发症较多,探讨发生并发症后的处理方法.方法：103例全甲状腺切除术中,均显露双侧喉返神经,发生喉返神经损伤的3例,其中肿瘤浸润喉返神经的2例,显露喉返神经时损伤1例,行喉返神经吻合术2例;本组未显露喉上神经; 显露双侧4枚甲状旁腺者14例,显露双侧3枚甲状旁腺者27例,显露双侧2枚甲状旁腺者46例,仅显露1枚甲状旁腺9例,未显露甲状旁腺者6例,术中未能显露而疑似误切1枚甲状旁腺并切取该组织一块小薄片送快速病理切片证实为甲状旁腺而将其切成薄片移植于胸锁乳突肌者1例.永久性甲状旁腺功能减退1例,行反复多次胎儿甲状旁腺移植.结果：本组103例甲状腺全切除术后发生发生短暂性甲状旁腺功能减退5例,永久性甲状旁腺功能减退1例,喉返神经损伤3例,喉上神经损伤2例.其中从喉上神经损伤2例中的临床表现,确认1例损伤在喉上神经的主干,术后患者发生短暂性饮食呛咳,发音低沉,1例损伤喉上神经的内侧支,术后也是发生短暂性饮食呛咳,而发生短暂性饮食呛咳均在术后3个月内消失;喉返神经损伤的患者终身声音嘶哑、发音困难,但是该3例患者在术后3~12月声音嘶哑、发音困难等症状在长期口服神经营养药如甲钴胺均稍有改善,其中行喉返神经吻合的2例声音嘶哑、发音困难恢复的时间最短,症状改善的情况要明显优于未行喉返神经吻合的患者;发生短暂性甲状旁腺功能减退的5例患者经短暂的静脉使用10%葡萄糖酸钙,然后口服钙尔奇,大多数在术后15天口唇麻木、面部肌肉和四肢抽搐的症状改善最终消失;1例永久性甲状旁腺功能减退的患者在术后3个月以内静脉使用10%葡萄糖酸钙同时口服钙尔奇,症状仍不能改善后给予反复多次同种异体胎儿甲状旁腺移植术,该患者得到治愈.结论：术中常规显露喉返神经是减少该神经损伤的最有效的方法;术中发现喉返神经损伤应立即在显微外科的基础上行喉返神经的吻合;术中的快速病理是避免误切甲状旁腺的必不可少的检查方法;反复多次的胎儿甲状旁腺移植能够治愈永久性的甲状旁腺功能减退的病例.
Objective：To discuss therapeutic methods for complications of total thyroidectomy（TT）. Method Retrospectively assay the therapeutic methods for complications in 11 cases of TT in 103 patients. Result temporary parathyroid gland dysfunction in 5 cases . injury of recurrent in 3 cases . The conservative treatment and symptoms were reliefin 8 cases . anastomosis of recurrent nerve in 2 cases and repead fetal parathyoid gland transplantation in one case , Conclude enough exposure recurrent nerve and immediate anastomosis it when find recurrent injury during surgery was beneficial for prognosis, fetal parathyroid transplantation was effective for persist parathy gland dysfunction . in addition, neurotrophic and caltrate et al were necessary for therapeutic comolications of TT.
关键词
甲状腺全切除术
并发症
损伤
Total Thyroidectomy TT
Complication
Recurr.ent nerve
