甲状旁腺及其附属脂肪的整体保护技术在甲状腺全切除术中的应用效果
|
摘要
目的:探讨甲状旁腺及其附属脂肪的整体保护技术在甲状腺全切除术中的应用效果。方法:选择2016年9月至2017年12月在广西桂林医学院附属医院行甲状腺全切除术的50例甲状腺癌患者为研究对象,术中对甲状旁腺及其附属脂肪行整体保护,观察其分布情况;检测患者术前和术后3 d、1个月血钙和血清甲状旁腺激素(PTH)水平。结果:82.0%(41/50)患者的甲状旁腺存在特异性附属脂肪,共计138枚,占甲状旁腺总数(182枚)的75.8%。附属脂肪均有微小血管及血管网提供血供。术后3 d,血钙及血清PTH水平低于术前(均P<0.05);低钙血症发生率为22.0%。术后1个月,血钙水平低于术前(P<0.05),而血清PTH水平与术前比较差异无统计学意义(P>0.05)。短暂性低钙血症发生率为2.0%,永久性低钙血症发生率为0.0%。结论:甲状腺全切除术中,甲状旁腺及其附属脂肪组织的整体保护可明显降低术后低钙血症的发生,其机制可能与甲状旁腺血供的破坏减少相关。
Objective:To investigate the clinical value of parathyroid attachment fat protection during total thyroidectomy.Methods:A total of 50 patients with thyroid cancer who underwent total thyroidectomy in our hospital from September 2016 to December 2017 were selected.Serum calcium and parathyroid hormone(PTH) levels were detected before operation and after 3 days and 1 month of operation.Results:Parathyroid gland with attached adipose tissue was found in 82.0%(41/50) patients,accounting for 75.8%(138/182) of all detected parathyroid glands.Microvascular and vascular network were seen in/on attached adipose tissue of parathyroid glands.On day 3 after surgery,the levels of serum calcium and PTH were decreased(P<0.05).The incidence of hypocalcemia was 22.0%.One month after operation,the serum calcium level was decreased(P<0.05),but no significant change was noted in serum PTH level(P>0.05).The incidence of transient hypocalcemia was 2.0% and the incidence of permanent hypocalcemia was 0.0%.Conclusion:Preserving parathyroid glands and its attached adipose tissue intact significantly reduced the incidence of postoperative hypocalcemia in total thyroidectomy,and the mechanism might be related to the improvement of blood supply to parathyroid glands.
Objective:To investigate the clinical value of parathyroid attachment fat protection during total thyroidectomy.Methods:A total of 50 patients with thyroid cancer who underwent total thyroidectomy in our hospital from September 2016 to December 2017 were selected.Serum calcium and parathyroid hormone(PTH) levels were detected before operation and after 3 days and 1 month of operation.Results:Parathyroid gland with attached adipose tissue was found in 82.0%(41/50) patients,accounting for 75.8%(138/182) of all detected parathyroid glands.Microvascular and vascular network were seen in/on attached adipose tissue of parathyroid glands.On day 3 after surgery,the levels of serum calcium and PTH were decreased(P<0.05).The incidence of hypocalcemia was 22.0%.One month after operation,the serum calcium level was decreased(P<0.05),but no significant change was noted in serum PTH level(P>0.05).The incidence of transient hypocalcemia was 2.0% and the incidence of permanent hypocalcemia was 0.0%.Conclusion:Preserving parathyroid glands and its attached adipose tissue intact significantly reduced the incidence of postoperative hypocalcemia in total thyroidectomy,and the mechanism might be related to the improvement of blood supply to parathyroid glands.
引文
[1] CHOW T L,CHOI C Y,CHIU A N,et al.Postoperative PTH monitoring of hypocalcemia expedites discharge after thyroidectomy[J].American Journal of Otolaryngology,2014,35(6):736-740.
[2] LEE D Y,CHA W,JEONG W J,et al.Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia[J].Laryngoscope,2014,124(5):1272-1277.
[3] PRADEEP P V,RAMALINGAM K,JAYASHREE B.Post total thyroidectomy hypocalcemia:a novel multi-factorial scoring system to enable its prediction to facilitate an early discharge[J].Journal of Postgraduate Medicine,2013,59(1):4-8.
[4] PRAZENICA P, O’KEEFFE L, HOLY R. Dissection and identification of parathyroid glands during thyroidectomy:association with hypocalcemia[J].Head & Neck,2015,37(3):393-399.
[5] JI Y B,LEE D W,SONG C M,et al.Accuracy of intraoperative determination of central node metastasis by the surgeon in papillary thyroid carcinoma[J].Otolaryngologyhead and Neck Surgery,2014,150(4):542-547.
[6] JI Y B,LEE K J,PARK Y S,et al.Clinical efficacy of sentinel lymph node biopsy using methylene blue dye in clinically node-negative papillary thyroid carcinoma[J].Annals of Surgical Oncology,2012,19(6):1868-1873.
[7] JULIAN M T, BALIBREA J M, GRANADA M L, et al.Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term[J].American Journal of Surgery,2013,206(5):783-789.
[8] JI Y B,SONG C M,SUNG E S,et al.Postoperative hypoparathyroidism and the viability of the parathyroid glands during thyroidectomy[J].Clinical and Experimental Otorhinolaryngology,2017,10(3):265-271.
[9] EL MALKI H O,ABOUQAL R.Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia [J].British Journal of Surgery,2014,101(4):307-320.
[10] SONG C M,FAU J H,JUNG J H,et al.Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy[J].World J Surg Oncol,2014,12:200.
[11] PARK I,RHU J,WOO J W,et al.Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia[J].World Journal of Surgery,2016,40(6):1382-1389.
[12] 王飞亮,缪刚,韦军民,等.甲状腺全切除术中对甲状旁腺特异性附着脂肪进行保护的临床和解剖研究[J].中华外科杂志,2016,54(11):859-863.
[13] MIZUNO H,TOBITA M,UYSAL A C.Concise review:sdipose-derived stem cells as a novel tool for future regenerative medicine[J].Stem Cells(Dayton,Ohio),2012,30(5):804-810.
[14] HONG S J,TRAKTUEV D O,MARCH K L.Therapeutic potential of adipose-derived stem cells in vascular growth and tissue repair[J].Current Opinion in Organ Transplantation,2010,15(1):86-91.
[2] LEE D Y,CHA W,JEONG W J,et al.Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia[J].Laryngoscope,2014,124(5):1272-1277.
[3] PRADEEP P V,RAMALINGAM K,JAYASHREE B.Post total thyroidectomy hypocalcemia:a novel multi-factorial scoring system to enable its prediction to facilitate an early discharge[J].Journal of Postgraduate Medicine,2013,59(1):4-8.
[4] PRAZENICA P, O’KEEFFE L, HOLY R. Dissection and identification of parathyroid glands during thyroidectomy:association with hypocalcemia[J].Head & Neck,2015,37(3):393-399.
[5] JI Y B,LEE D W,SONG C M,et al.Accuracy of intraoperative determination of central node metastasis by the surgeon in papillary thyroid carcinoma[J].Otolaryngologyhead and Neck Surgery,2014,150(4):542-547.
[6] JI Y B,LEE K J,PARK Y S,et al.Clinical efficacy of sentinel lymph node biopsy using methylene blue dye in clinically node-negative papillary thyroid carcinoma[J].Annals of Surgical Oncology,2012,19(6):1868-1873.
[7] JULIAN M T, BALIBREA J M, GRANADA M L, et al.Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term[J].American Journal of Surgery,2013,206(5):783-789.
[8] JI Y B,SONG C M,SUNG E S,et al.Postoperative hypoparathyroidism and the viability of the parathyroid glands during thyroidectomy[J].Clinical and Experimental Otorhinolaryngology,2017,10(3):265-271.
[9] EL MALKI H O,ABOUQAL R.Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia [J].British Journal of Surgery,2014,101(4):307-320.
[10] SONG C M,FAU J H,JUNG J H,et al.Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy[J].World J Surg Oncol,2014,12:200.
[11] PARK I,RHU J,WOO J W,et al.Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia[J].World Journal of Surgery,2016,40(6):1382-1389.
[12] 王飞亮,缪刚,韦军民,等.甲状腺全切除术中对甲状旁腺特异性附着脂肪进行保护的临床和解剖研究[J].中华外科杂志,2016,54(11):859-863.
[13] MIZUNO H,TOBITA M,UYSAL A C.Concise review:sdipose-derived stem cells as a novel tool for future regenerative medicine[J].Stem Cells(Dayton,Ohio),2012,30(5):804-810.
[14] HONG S J,TRAKTUEV D O,MARCH K L.Therapeutic potential of adipose-derived stem cells in vascular growth and tissue repair[J].Current Opinion in Organ Transplantation,2010,15(1):86-91.