| Objective:To investigate the surgical techniques of how to expose,identify and protect the parathyroid glands(PTGs) and their blood supply during thyroidectomy by naked eyes,in order to prevent the permanent hypoparathyroidism.Method:752 patients were operated during the August 2007 to February 2009. Protective measure of parathyroid glands and its blood supply was observed during the operation by eyes,including the number,location and the blood supply of the PTGs were recoded.Result:Of the 752 thyroidectomy,there were 1～4 PTGs were found in 718 operation, and no PTG was found in others.There were 1185 superior PTGs were found which were almost consistently located(89.28%) in the level of inferior edge of the thyroid cartilage (near the cricothyroid joint).There were 173 superior PTGs' vessels were found in thyroidectomy,which were often(75.72%) from the upper branch of inferior thyroid artery (ITA),1238 inferior PTGs were found intraoperatively,and which were more variable in their location..Approximately 49.52%inferior PTGs were located in the lateral or rear of the 1/3 inferior thyroid pole,24.72%were positioned immediately inferior to the inferior thyroid pole,which the ITA branches insert into the thyroid.There were 334 inferior PTGs' vessels were exposed.The blood supplies of inferior PTGs were also from the inferior branches of ITA system(92.51%).Conclusion:The PTGs and their blood supply can be exposed and protected intraoperatively by naked eyes.The blood supplies of parathyroid glands are associated with their location.The superior PTGs were almost consistently located in the level of inferior edge of the thyroid cartilage(near the cricothyroid joint).Whose blood supplies were often from the upper branch of inferior thyroid artery(ITA).The inferior PTGs were more variable in their location.Most of them were located in the lateral or rear of the 1/3 inferior thyroid pole or the immediately inferior to the inferior thyroid pole,which the IT.A branches insert into the thyroid.Most the blood supplies of inferior PTGs were also from the inferior branches of ITA system.To prevent this complication,the PTGs should been protected in situ through meticulous dissection without injuring their blood supply,or could autotransplant the jeopardized parathyroid glands. Objective:By giving the preventive calcium supplementation to the total thyroidectomy patients after their operations,to discuss the influence of preventive calcium supplementation to the hypoparathyroidism patients.Method:168 patients were conducted total thyroidectomy during the August 2007 to February 2009,and whose 3 or 4 parathyroid glands were protected in situ.These patients were divided into 2 groups.There were 84 patients in group A,whom were immediately supplemented Prophylactic 10%calcium gluconate intravenously 10g/d after operations. Another 84 patients in group B were observed after operations,anyone in group B developed the syndromes of hypocalcaemia were supplemented Prophylactic 10%calcium gluconate intravenously 10g/d at this time.If patients who were supplementing calcium gluconate still had syndromes would add the calcium does to 12～14g/d.The serum calcium and PTH of all patients were assayed in the first,second,and third day after the operations.The developing of hypocalcaemia syndromes were also observed.Patients had never developed hypoparathyroidism in the first 3days post-operation could discharge and stop their calcium supplementation therapy.The hypoparathyroidism patients continued their monitoring in the 5th and 7th day after operation,and still their calcium supplementation.The calcium supplementation method of these patients was change to oral therapy(calcium carbonate and vitamin D3 tablet,4800 mg/d).All hypoparathyroidism patients could control the syndromes attacking by oral calcium supplementation.So they discharged in the 8th day after operations. The hypoparathyroidism patients were followed up in each week post-thyroidectomy until the syndromes of hypocalcaemia disappeared.Result:There were 18 hypoparathyroidism patients in group A.After the preventively calcium supplementation 5 hypoparathyroidism patients attacked syndromes.There were 20 hypoparathyroidism patients in group B.These patients developed syndromes of hypocalcaemia,and there were 5 in whom attacked syndromes again after the calcium supplementation.The maximum does of calcium therapy in group A was 12g/d,and which in group B was 14g/d.The variance of the calcium does between these two groups was no significance(P＞0.05).The variance of the serum PTH levels in the first 3days post-operation between two groups was no significance(P＞0.05),but the serum calcium of group A was high than group B(P＜0.05).The variance of the serum PTH and calcium levels in the 5th day and 1st week,2nd week,and 3rd week post-operation between two groups had significance(P＜0.05),and which in group A were higher than group B respectively.The serum PTH and calcium levels reached the preoperative levels in the 2nd week and 3rd week after operation respectively in group A.the syndromes of hypocalcaemia patients in group A disappeared in the 3rd postoperative week.The serum PTH and calcium levels reached the preoperative levels in the 2nd week and 4th week after operation respectively in group B.the syndromes of hypocalcaemia patients in group B disappeared in the 5th postoperative week. The variance between two groups was significance respectively(P＜0.05).Conclusion:The preventively calcium supplementation post-thyroidectomy can abate the syndromes of hypocalcaemia efficiently.And also can reduce the stimulation to the injured parathyroid glands because of hypo-calcium.So this mechanism is beneficial for the parathyroid glands recovering functionally.Some hypoparathyroidism patients still have the feeling of hypocalcaemia while whose serum calcium level had reach their preoperative level, this may because of psychological suggestion.The preventively calcium supplementation can lessen the psychological influence of hypocalcaemia to these patients.
|
PDF Full Text Request