CAJ | 학술논문

目的评估甲状腺手术中自体移植甲状旁腺的功能,为甲状旁腺自体移植的有效性提供理论根据.方法检测120例甲状旁腺正常志愿者双侧肘部头静脉血清中甲状旁腺素,将其作为正常对照,检测34例在甲状腺手术中由于误切或因缺血等原因无法保留的甲状旁腺进行自体移植的患者作为实验组,将甲状旁腺移植于患者的非正力侧前臂肱桡肌肌腹内,分别于手术当日、术后3d、7d及术后2个月检测移植甲状旁腺在双侧肘部头静脉血清中的甲状旁腺素质量浓度,根据移植后其差值,判定移植甲状旁腺是否成活并具有分泌功能.结果正常对照组120例志愿者双侧肘部头静脉血清甲状旁腺素差值的绝对值平均((x)±s)为(1.19±0.98) ng/L,极大差值为4.52 ng/L,本研究以极大差值的2倍即9.04 ng/L作为评估实验组受试者甲状旁腺自体移植有效的标准.实验组34例患者术后2个月甲状旁腺移植有效例数为26例,有效率为76.5％( 26/34).结论大多数自体移植的甲状旁腺具有分泌功能,因此在甲状腺手术中对已经游离或严重缺血的甲状旁腺进行自体移植是保留甲状旁腺功能的有效方法.
목적 평고갑상선수술중자체이식갑상방선적공능,위갑상방선자체이식적유효성제공이론근거.방법 검측120례갑상방선정상지원자쌍측주부두정맥혈청중갑상방선소,장기작위정상대조,검측34례재갑상선수술중유우오절혹인결혈등원인무법보류적갑상방선진행자체이식적환자작위실험조,장갑상방선이식우환자적비정력측전비굉뇨기기복내,분별우수술당일、술후3d、7d급술후2개월검측이식갑상방선재쌍측주부두정맥혈청중적갑상방선소질량농도,근거이식후기차치,판정이식갑상방선시부성활병구유분비공능.결과 정상대조조120례지원자쌍측주부두정맥혈청갑상방선소차치적절대치평균((x)±s)위(1.19±0.98) ng/L,겁대차치위4.52 ng/L,본연구이겁대차치적2배즉9.04 ng/L작위평고실험조수시자갑상방선자체이식유효적표준.실험조34례환자술후2개월갑상방선이식유효례수위26례,유효솔위76.5％( 26/34).결론 대다수자체이식적갑상방선구유분비공능,인차재갑상선수술중대이경유리혹엄중결혈적갑상방선진행자체이식시보류갑상방선공능적유효방법.
Objective To evaluate the function autotransplanted parathyroid tissues in thyroid surgery.Methods The control group comprised 120 volunteers with normal parathyroid glands in whom serum parathyroid hormone (PTH) levels in blood samples taken from the bilateral elbow head veins.The experimental group comprised 34 patients in whom the parathyroid glands,which were mistakenly cut or could not be preserved during thyroid surgery because of ischemia,were fragmented and autografted into the brachioradialis muscle of the nondominant forearm.On the day of surgery and at 3 days,7 days,and 2 months postoperatively,contrast imaging and detection of serum PTH levels were performed to evaluate the function of the transplanted parathyroid tissues.Results In the control group,the mean value of the difference between the bilateral brachiocephalic vein PTH levels was ( 1.19 ± 0.98 ) ng/L ( maximum 4.52 ng/L).In this study,twice the maximum value(9.04 ng/L) was taken as the effective standard.Based on the 9.04 ng/L effective value,the effective number was 26 patients and the effective rate was 76.5％ at 2 months postoperatively in the 34 patients of the experimental group.Conclusions The autotransplanted parathyroid tissues showed their dunctions in most patients,therefore,parathyroid gland autotransplantation is an effective method of preserving function of parathyroid glands that are free or severely ischemic in thvroid surgery.