Department of Otolaryngology-Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
Laryngoscope. 2013 Sep;123(9):2324-8. doi: 10.1002/lary.23954. Epub 2013 Jun 3.
OBJECTIVES/HYPOTHESIS: Routine identification of all four parathyroid glands has been advocated as a means of reducing rates of postoperative hypocalcemia and inadvertent parathyroidectomy. The object of the present study was to investigate whether identification of more parathyroid glands during thyroidectomy performed by capsular dissection technique had any impact on incidence of postoperative hypocalcemia and unintentional parathyroid resection.
Prospective cohort study of consecutive patients undergoing total thyroidectomy by capsular dissection technique over a 3-year period. Exclusion criteria included performance of concomitant central neck dissection, hyperparathyroidism, revision surgery, and invasive cancer.
The number of parathyroid glands identified intraoperatively was recorded. No effort was made to find glands that were not obviously apparent during the course of dissection. Patients were not placed on routine calcium supplementation.
The final study population consisted of 126 patients. The mean number of parathyroid glands identified was 2.3. The incidence of biochemical (any postoperative calcium <2 mmol/L) and clinical hypocalcemia was 22.2% and 10.3%, respectively. Patients in group A (0-2 parathyroids identified) had a significantly lower incidence of clinical hypocalcemia than patients in group B (3-4 parathyroids identified) (3.2% vs. 17.1%, P = .02). The differences in biochemical hypocalcemia were not significant (16.1% vs. 28.1%, P = .13). The incidence of inadvertent parathyroidectomy was 9.5%. There was no difference between the groups in incidence of inadvertent parathyroidectomy (9.7% vs. 9.4%, P = 1.0).
Routine identification of all four parathyroid glands is not necessary in thyroidectomy performed using capsular dissection technique.
目的/假设：常规识别所有四个甲状旁腺被认为是降低术后低钙血症和甲状旁腺意外切除发生率的一种手段。本研究的目的是研究在采用囊外解剖技术进行甲状腺切除术时，识别更多的甲状旁腺是否会对术后低钙血症和意外甲状旁腺切除的发生率产生影响。
对 3 年内采用囊外解剖技术行全甲状腺切除术的连续患者进行前瞻性队列研究。排除标准包括同时进行中央颈部清扫术、甲状旁腺功能亢进、翻修手术和浸润性癌症。
记录术中识别的甲状旁腺数量。在解剖过程中没有刻意寻找不明显的腺体。患者未常规补充钙。
最终的研究人群包括 126 例患者。平均识别出的甲状旁腺数量为 2.3 个。生化（任何术后血钙<2mmol/L）和临床低钙血症的发生率分别为 22.2%和 10.3%。在 A 组（识别出 0-2 个甲状旁腺）中，临床低钙血症的发生率明显低于 B 组（识别出 3-4 个甲状旁腺）（3.2%比 17.1%，P=0.02）。生化低钙血症的差异无统计学意义（16.1%比 28.1%，P=0.13）。意外甲状旁腺切除的发生率为 9.5%。两组间意外甲状旁腺切除的发生率无差异（9.7%比 9.4%，P=1.0）。
在采用囊外解剖技术进行甲状腺切除术时，没有必要常规识别所有四个甲状旁腺。
