甲状腺全切除术时甲状旁腺的识别与自体移植的效果。
Outcomes of parathyroid gland identification and autotransplantation during total thyroidectomy.
机构信息
Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India.
Endocrinology, Kovai Medical Center and Hospital, Coimbatore, India.
出版信息
Eur Arch Otorhinolaryngol. 2020 Aug;277(8):2319-2324. doi: 10.1007/s00405-020-05941-9. Epub 2020 Mar 30.
PURPOSE
To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy.
METHODS
Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes.
RESULTS
In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism.
CONCLUSION
The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.
目的
报告甲状腺切除术期间甲状旁腺（PG）识别和自体移植（autoT）的结果。
方法
连续纳入了一位外科医生采用囊外解剖技术进行的全甲状腺切除术病例。在解剖过程中不刻意寻找 PG。前瞻性记录 PG 的位置、识别数量和 autoT，并与术后结果相关联。
结果
共纳入 265 例病例。平均每例识别的 PG 数量为 2.7。识别的 PG 数量与术后低钙血症无关。然而，低钙血症的独立危险因素为女性、双侧中央区颈部清扫术（CND）和＞1 个 PG 的 autoT；永久性甲状旁腺功能减退症的独立危险因素为女性和双侧 CND。autoT 并不能预防永久性甲状旁腺功能减退症。
结论
在标准囊外解剖技术过程中识别的 PG 数量与术后低钙血症无关。只要可能，建议避免双侧 CND，并采用仔细的技术将 PG 原位和存活状态保存下来，以避免需要进行 autoT。
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