Sadacharan Dhalapathy, Mahadevan Shriraam, Sathya Anjali, Gopal Jayashree, Murthy S, Chandrashekaran Shruti, Shanmugasundar G, Rao Smitha S
Department of Endocrine Surgery, Madras Medical College, Chennai, Tamil Nadu, India.
Department of Endocrinology, Sri Rama Chandra Institute of Medical Sciences, Chennai, Tamil Nadu, India.
J Family Med Prim Care. 2020 Feb 28;9(2):632-636. doi: 10.4103/jfmpc.jfmpc_1141_19. eCollection 2020 Feb.
Modern thyroid surgery has undergone a paradigm shift from subtotal thyroidectomy to an extended total thyroidectomy (TT) even for benign disorders. This entails removal of all embryological remnants even in benign disorders.
To study the prevalence of various embryological remnants of the thyroid and surgical utility and implications in preventing complications.
Retrospective study of total thyroidectomies done by a single endocrine surgeon by standardized technique.
A detailed search of all embryological rests including Pyramidal tract (PT), Tubercle of Zuckerkandl (TZ), and Thyro-thymic thyroid rests (TTR) were done in 1118 patients undergoing TT over 6 years. The cases with and without TTR were divided as Group A and B, respectively. Their prevalence and impact on parathyroid preservation and other clinical parameters were analysed.
Descriptive analyses.
Out of the 1118 TT cases, TTR was seen in 230 (20.57%) cases, TZ in 598 (53.48%), cases and PT in 641 (57.33%) cases. Among group-A ( = 230), 213 had unilateral and 17 had bilateral TTR with 51 (22.17%) having retrosternal extension. Compressive symptoms, presence of TZ and PT were also significantly higher in group A. On follow up the incidence of temporary hypoparathyroidism was significantly higher in group-A, where as permanent hypoparathyroidism, temporary and permanent vocal cord palsy were comparable between the two study groups.
Embryological remnants related to thyroid are not uncommonly encountered during total thyroidectomy. A thorough search and complete removal is crucial for the successful outcome of the procedure.
现代甲状腺手术已经经历了从甲状腺次全切除术到扩大全甲状腺切除术（TT）的模式转变，即使是针对良性疾病。这意味着即使在良性疾病中也要切除所有胚胎学残余组织。
研究甲状腺各种胚胎学残余组织的发生率、手术实用性以及预防并发症的意义。
对一位内分泌外科医生采用标准化技术进行的全甲状腺切除术进行回顾性研究。
对1118例在6年期间接受TT手术的患者中所有胚胎学残余组织进行详细检查，包括锥体叶（PT）、祖克坎德尔结节（TZ）和甲状腺胸腺残余组织（TTR）。有和没有TTR的病例分别分为A组和B组。分析它们的发生率以及对甲状旁腺保留和其他临床参数的影响。
描述性分析。
在1118例TT病例中，230例（20.57%）发现有TTR，598例（53.48%）发现有TZ，641例（57.33%）发现有PT。在A组（n = 230）中，213例为单侧TTR，17例为双侧TTR，其中51例（22.17%）有胸骨后延伸。A组中压迫症状、TZ和PT的存在也显著更高。随访时，A组临时甲状旁腺功能减退的发生率显著更高，而永久性甲状旁腺功能减退、临时和永久性声带麻痹在两个研究组之间相当。
在全甲状腺切除术中，与甲状腺相关的胚胎学残余组织并不罕见。彻底检查和完全切除对于手术的成功结果至关重要。
