原位保留甲状旁腺血供及甲状旁腺自体移植术

摘要

Objective To introduce the processes of vascularized parathyroid gland reservation and parathyroid autotransplantation applied in thyroidectomy. Methods In 46 cases who underwent totalear total thyroidectomy, in situ vascularized parathyroid gland reservation was performed in 24 cases,isolated parathyroid autotransplantation was performed in 5 cases, in situ vascularized parathyroid gland reservation of 1～2 parathyroid glands combined with immediately transplantation of the remaining isolated parathyroid glands were performed in 17 cases. Results Five cases suffered from transient hypocalcaemia, including 2 cases of vascularized parathyroid gland reservation and 3 cases of vascularized parathyroid gland reservation in 1～2 parathyroid glands combined with immediately transplantation of other parathyroid glands. Two cases who received parathyroid autotransplantation suffered from hypocalcaemia and received conservative treatment with activated vitamin D3 and caleium for 4 weeks or 8 weeks. Permanent hypoparathyroidism occurred in 1 case of 46 cases which undergone the totalear total thyroidectomy(2.2%). Conclusion Application of vascularized parathyroid gland reservation and parathyroid autotransplantation in totalear total thyroidectomy could reduce the incidence rate of post-operative hypoparathyroidism.%目的 介绍甲状腺肿瘤手术中保护甲状旁腺血供及甲状旁腺自体移植的方法及疗效.方法 46例全甲状腺切除或近全切除手术中,血管化甲状旁腺保留24例,单纯自体甲状旁腺移植5例,1～2枚甲状旁腺血管化保留同时其余甲状旁腺Ⅰ期自体移植17例.结果 应用此法行全甲状腺切除或近全切除患者中,有2例原位血管化保留甲状旁腺及3例血管化保留+自体甲状旁腺移植患者术后48～72 h内出现一过性低血钙,予以补钙后3 d左右恢复正常.2例单纯甲状旁腺自体移植患者术后出现低血钙,服用钙尔奇D/罗盖全4周～8周后复查血钙维持在正常水平.术后出现永久性甲状旁腺功能低下的仅1例(2.2%).结论 血管化甲状旁腺保留及自体甲状旁腺移植可大大降低全甲状腺切除或近全切除手术导致甲状旁腺功能低下的发生率.