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目的:探讨精细化被膜解剖法在分化型甲状腺癌手术中的应用价值。方法:回顾2011年3月—2015年3月75例行全甲状腺切除+中央组淋巴结清扫术的分化型甲状腺癌患者资料,患者均采用精细化被膜解剖法对甲状旁腺的识别与原位保留,对于严重缺血或误切的甲状旁腺,术中及时进行自体移植。结果:75例患者中,46例术中确认并原位保留甲状旁腺4枚,其余原位保留2~3枚。手术后12h,部分患者出现口角及手足麻木、轻度抽搐,无1例患者出现呼吸困难、休克等严重并发症;术后1个月,血清钙<2.0mmol/L18例,术后2~3个月,血清钙<2.0mmol/L11例,术后4~6个月,患者血清钙均>2.0mmol/L。术后随访16~18个月,患者血清钙>2.0mmol/L,无临床低钙症状。结论:在分化型甲状腺癌患者手术中,运用精细化被膜解剖法,有助于精准识别甲状旁腺并最大可能的原位保留甲状旁腺及其功能。
Objective: To investigate the application value of fine dissection in differentiated thyroid cancer. Methods: From March 2011 to March 2015, 75 patients with differentiated thyroid cancer underwent total thyroidectomy and central lymph node dissection were retrospectively reviewed. The patients were examined by fine dissection to identify and preserve the parathyroid glands , For severe ischemia or misdiagnosed parathyroid, intraoperative timely autologous transplantation. Results: Of the 75 patients, 4 of the 75 parathyroid glands were confirmed and preserved in situ, while the others remained 2 to 3 in situ. Twelve hours after operation, some patients presented mouth numbness and numbness of hands and feet with mild convulsions. None of the patients had severe complications such as dyspnea and shock. One month after operation, serum calcium was less than 2.0 mmol / L in 18 patients and 2-3 Months, serum calcium <2.0mmol / L in 11 cases, 4 to 6 months after surgery, serum calcium were> 2.0mmol / L. All the patients were followed up for 16-18 months. Serum calcium was 2.0 mmol / L and no clinical symptoms were observed. Conclusion: In patients with differentiated thyroid cancer surgery, the use of fine dissection of the anatomy, help to accurately identify the parathyroid glands and the largest possible in situ preservation of the parathyroid gland and its function.