甲状腺下动脉解剖技术对中央区淋巴结清扫术中下甲状旁腺功能保护的意义

Significance of dissecting inferior thyroid artery for protection of 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 本研究实施CCND手术65例患者(双侧9例、单侧56例)，共解剖74侧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之后的血供情况及术后甲状旁腺激素(PTH)水平。结果 本组解剖ITA寻找到IPGs的比例为85.1%(63/74)；可肉眼识别的为56.8%(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 42.0%(31/74)；原位保留IPGs的成功率为59.5%(44/74)；有12.3%(8/65)的患者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，可有效保护其完好的血供与功能。

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 (9 bilateral cases and 56 unilateral cases) underwent CCND in our hospital were retrospectively analyzed. A total of 74 sides 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 recorded.Results The proportion of IPGs found by dissecting ITA in this group was 85.1% (63/74); 54.1% (42/74) IPGs that could 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 the patients 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.