中国实用外科杂志

中国实用外科杂志

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内镜观察术中原位保留甲状旁腺可行性研究

马云海a，钱    军a，李书聆b，尹    哲a，程若川a   

  1. 昆明医科大学第一附属医院 a.甲状腺外科 b.耳鼻喉科，云南昆明650032
  • 出版日期:2016-05-01 发布日期:2016-04-28

  • Online:2016-05-01 Published:2016-04-28

摘要：

目的    探讨通过术中留置于甲状腺床的引流管应用内镜观察原位保留的目标甲状旁腺的可行性。方法    选择2015年2-6月昆明医科大学第一附属医院甲状腺疾病诊治中心行单侧甲状腺切除术的14例病人为研究对象，均为单侧甲状腺良性肿瘤或单侧甲状腺微小乳头状癌。术中在目标甲状旁腺同侧留置引流管，术后24 h和48 h通过该引流管用内镜观察目标甲状旁腺的存活情况。结果    通过内镜观察甲状旁腺14枚，其中上甲状旁腺7枚，下甲状旁腺7枚，术后24 h清晰观察甲状旁腺13枚，48 h观察到甲状旁腺8枚。术中7枚上甲状旁腺中6枚有肉眼可辨的血管蒂相连，1枚无明显血管蒂，该枚上甲状旁腺术后24 h、48 h观察腺体均为黑色，认为坏死可能，其余上甲状旁腺无坏死表现。6枚下甲状旁腺原位保留后只有2枚有明显的血管蒂，其余4枚无血管蒂；24 h后观察到2枚有轻度淤血表现，其余4枚色泽正常；48 h后3枚观察失败，3枚色泽正常。结论    甲状腺手术后可通过术中留置的引流管应用内镜观察甲状旁腺的存活情况。

关键词: 甲状腺手术, 甲状旁腺, 内镜

Abstract:

Feasibility study of parathyroid glands retained in situ during endoscopic observation        MA Yun-hai*，QIAN Jun，LI Shu-ling，et al. Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University，Kunming 650032，China
Corresponding author：CHEN Ruo-chuan，E-mail：cruochuan@foxmail.com
Abstract    Objective    To observe the dynamic condition of the target parathyroid glands with intra-operative tag by endoscope across the drainage tube detained at the thyroid gland bed. Methods    Fourteen patients with either unilateral thyroid benign tumor or unilateral papillary thyroid microcarcinoma performed unilateral thyroidectomy from February 2015 to June 2015 in Center of Diagnosis and Treatment of Thyroid Disease, the First Affiliated Hospital of Kunming Medical University were adopted in the study. The drainage tube was placed at the same side of the target parathyroid glands during operation. The survival and imaging data were obtained at 24 h and 48 h of post-operation under rigorously sterile condition by endoscope across drainage tube previously detained. Results    By endoscope across the drainage tube，fourteen parathyroid glands including seven superior parathyroid glands and seven inferior parathyroid glands were clearly observed. In addition，thirteen and eight parathyroid glands were also observed at 24 h and 48 h of post-operation，respectively. Six of seven superior parathyroid glands were connected with macroscopic vascular pedicle，while the one which was black in colour at 24 h and 48 h of post-operation was insular and considered be thanatosis. As for six inferior parathyroid glands in situ，vascular pedicle was observed only in two of six. Furthermore，two of six inferior parathyroid glands had the symptom of faint extravasated blood while the other four were normal in colour at 24 h of post-operation. Whereafter，three inferior parathyroid glands were unable to be observed but the other three were normal in colour. Conclution    It is feasible to detect the survival of parathyroid glands post-operation by endoscope across the drainage tube detained during operation.

Key words: thyroid surgery, parathyroid glands, endoscope