目的 探讨继发性甲状旁腺功能亢进症手术中，“蝶形”游离甲状腺叶并预防性切除甲状腺下动脉对于清扫甲状旁腺的意义。 方法 回顾2020年5月至2024年2月本院确诊继发性甲状旁腺功能亢进症并予以甲状旁腺全切除联合自体移植术治疗的患者67例，其中离断甲状腺下动脉患者31例（研究组），保留甲状腺下动脉患者36例（对照组）。对比围手术期指标及术后远期情况，评价手术疗效。 结果 研究组术前术后甲状腺功能及影像学结果对比，差异无统计学意义；两组患者手术时间、术中出血量、术后1 d引流量及术后住院时间结果对比，差异无统计学意义；两组患者术后10 min、1 h、1 d、1周、1月的甲状旁腺激素结果对比，差异无统计学意义；研究组术后3月及6月甲状旁腺激素较低（P<0.05）。 结论 结合术前影像学定位，“蝶形”游离甲状腺有利于暴露常规位置的甲状旁腺；是否切除甲状腺下动脉在手术难度及术后恢复上无明显差异且不会影响患者甲状腺功能；预防性切除甲状腺下动脉有降低远期复发的可能，更适用于甲状旁腺异位及术中难以辨别清扫范围的患者。
Abstract
Objective To investigate the significance of 'butterfly-shaped' free dissection of the thyroid lobe and prophylactic resection of the inferior thyroid artery during the surgical treatment of secondary hyperparathyroidism. Methods From May 2020 to February 2024, 67 patients diagnosed with secondary hyperparathyroidism and underwent surgical treatment in our hospital were reviewed. All patients underwent total parathyroidectomy combined with autotransplantation, including 31 patients with resection of the inferior thyroid artery (study group) and 36 patients with preservation of the inferior thyroid artery (control group). The perioperative indicators and postoperative long-term conditions were compared to evaluate the surgical efficacy. Results There was no significant difference in thyroid function and imaging results between the study group before and after operation. There was no significant difference in the operation time, intraoperative blood loss, postoperative 1 d drainage volume and postoperative hospital stay between the two groups. There was no significant difference in parathyroid hormone results between the two groups at 10 min, 1 h, 1 d, 1 week and 1 month after operation. The parathyroid hormone in the study group was lower at 3 months and 6 months after operation (P<0.05). Conclusions The 'butterfly-shaped' free thyroid lobe is beneficial to expose the parathyroid gland in the conventional position, which is convenient to combine the preoperative imaging to locate the hyperplastic parathyroid gland. Whether to remove the inferior thyroid artery has no significant difference in the difficulty of surgery and postoperative recovery and will not affect the thyroid function of patients. Preventive resection of the inferior thyroid artery can reduce the possibility of long-term recurrence, and is more suitable for patients with ectopic parathyroid glands and difficult to identify the scope of dissection during the operation.
关键词
继发性甲状旁腺功能亢进症； /
/
甲状腺； /
/
甲状腺下动脉； /
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甲状旁腺激素
Key words
Secondary hyperparathyroidism; /
Parathyroid gland; /
Inferior thyroid artery; /
Parathyroid hormone
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基金
安徽省临床重点专科建设项目经费资助；安徽省高等学校科学研究项目（自然科学类）重大项目（2023AH040405）；安徽省卫生健康科研项目（省财政支持项目：AHWJ2023A10015）；安徽理工大学2023年度医学专项培育项目（H2重大项目：YZ2023H2A006）
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