檀谊洪,张永泉,陈晓意,王昆,曾昭游(南方医科大学附属南海医院甲状腺血管外科 广东佛山 528200 )

Significance of Dissecting Inferior Thyroid Artery to Protect Inferior parathyroid glands during Central Compartment Neck Dissection

摘要:

目的 探讨在甲状腺癌中央区淋巴结清扫术(CCND)中,采用甲状腺下动脉(ITA)解剖技术来保护下甲状旁腺(IPGs)功能的意义。方法 我院实施的CCND手术65例患者(双侧9例、单侧56例),共解剖74例ITA来寻找和保护IPGs,记录术中寻找IPGs的数目、解剖ITA情况、保留IPGs之后的血供情况、术后甲状旁腺激素(PTH)。结果 本组解剖ITA寻找到IPGs的比例为85.1%(63/74)；可肉眼识别的54.1%(42/74)IPGs,可见明显的ITA的I级和II级分支血管供血,ITA发出走向胸腺舌的II级分支有41.8%(31/74)；原位保留IPGs的成功率为59.4%(44/74)；有12.3%(8/65)的病例术后出现暂时性甲状旁腺功能减退,2周后恢复正常。 结论 解剖ITA的方法有助于在CCND术中寻找到IPGs,并尽可能的保护其完好血供。

Abstract:

Objective To investigate the significance of dissecting the inferior thyroid artery (ITA) for protection of inferior parathyroid glands (IPGs) during central compartment neck dissection (CCND) for thyroid cancer. Methods A cohort of 65 patients including 9 bilateral and 56 unilateral throid cancer underwent CCND in our hospital were retrospectively analyzed. A total of 74 cases of ITA were dissected to find and protect IPGs. The number of IPGs found during surgery, ITA status, and preservation of blood supply after IPGs and the level of postoperative parathyroid hormone (PTH) were documented,. Results The proportion of IPGs found by dissecting ITA in this group was 85.1% (63/74); 54.1% (42/74) IPGs that can be identified by the naked eye. The blood supply of Grade I and Grade II branch blood vessels of ITA was obviously oberved, and the grade II branch from ITA to tongues of the thymus was 41.8% (31/74), the success rate of retaining IPGs in situ was 59.4% (44/74), and 12.3% (8/65) of cases had temporary hypoparathyroidism after surgery , which returned to normal level within 2 weeks. Conclusion The method of dissecting ITA is helpful for identifying IPGs during the CCND and preserving the blood supply satisfactorily.