CAJ | 학술논문

目的探讨甲状腺全切除术中甲状旁腺的显露定位及其血供的保护方法.方法回顾性分析辽宁省肿瘤医院头颈外科1990年2月至2009年12月期间296例甲状腺全切手术患者资料,术中显露并保护甲状旁腺及其血供,检测并对比术前、术后血清钙离子和甲状旁腺激素(parathyroid hormone,PTH)水平,对术后出现低钙症状和甲状旁腺功能低下者行支持治疗.结果 296例甲状腺全切手术中见上甲状旁腺共542枚,其中444枚(81.9%)位置恒定于甲状腺背面甲状软骨下缘水平;确切显露104枚上甲状旁腺的血管,其中71枚(68.3%)由甲状腺下动脉上行支供血.下甲状旁腺共467枚,位置变异较大,231枚(49.5%)位于甲状腺背面下1/3部分,116枚(24.8%)位于甲状腺侧叶最下端近甲状腺下动脉入腺体处;确切显露142枚下甲状旁腺的血管,其中114枚(80.3%)的血供来自甲状腺下动脉或最下动脉的分支.术后发生低钙血症13例,无一例发生永久性甲状旁腺功能低下.结论甲状旁腺血供来源与其位置有密切关系.甲状腺全切除及近全切除术中辨认和保护甲状旁腺及其血液供应,可有效防止术后甲状旁腺功能低下的发生.
목적 탐토갑상선전절제술중갑상방선적현로정위급기혈공적보호방법.방법 회고성분석요녕성종류의원두경외과1990년2월지2009년12월기간296례갑상선전절수술환자자료,술중현로병보호갑상방선급기혈공,검측병대비술전、술후혈청개리자화갑상방선격소(parathyroid hormone,PTH)수평,대술후출현저개증상화갑상방선공능저하자행지지치료.결과 296례갑상선전절수술중견상갑상방선공542매,기중444매(81.9%)위치항정우갑상선배면갑상연골하연수평;학절현로104매상갑상방선적혈관,기중71매(68.3%)유갑상선하동맥상행지공혈.하갑상방선공467매,위치변이교대,231매(49.5%)위우갑상선배면하1/3부분,116매(24.8%)위우갑상선측협최하단근갑상선하동맥입선체처;학절현로142매하갑상방선적혈관,기중114매(80.3%)적혈공래자갑상선하동맥혹최하동맥적분지.술후발생저개혈증13례,무일례발생영구성갑상방선공능저하.결론 갑상방선혈공래원여기위치유밀절관계.갑상선전절제급근전절제술중변인화보호갑상방선급기혈액공응,가유효방지술후갑상방선공능저하적발생.
Objective To explore the protection methods of parathyroid glands (PTGs) and their functions during total thyroidectomy. Methods The locations and the blood supplies of parathyroid glands in 292 cases underwent total thyroidectomy between February 1990 and December 2009 were studied. The protective measures for PTGs and their blood supplies during total thyroidectomy were analyzed. Results Total of 542 superior PTGs and 467 inferior PTGs were found in 296 cases of total thyroidectomy. Of the superior PTGs, 444 (81.9%) consistently located in the back sides of the thyroid glands and at the level of inferior edge of thyroid cartilage. The locations of the inferior PTGs were variable, 231 (49.5%) of them located in the inferior 1/3 part of the back sides of the thyroids and 116(24.8% ) at the inferior thyroid, in where inferior thyroid artery (ITA) branches enter thyroid. The fine dissections showed that the blood supplies to superior PTGs were mainly from the upper branch of ITA, accounting for 71 (68.3%) of 104 superior PTGs and the blood supplies to inferior PTGs were from the inferior branches of ITA system,accounting for 114(80. 3% ) of 142 inferior PTGs. There was 13 cases with short-term hypocalcemia postoperatively, but no case with permanent hypoparathyroidism. Conclusions The blood supplies of PTGs are associated with their locations. During total or subtotal thyroidectomy, parathyroid glands and their artery blood-supply should be exposed and preserved to prevent hypoparathyroidism after surgery.