陈军　王少军　汪刘华

摘要：目的 探讨在甲状腺全切除术中如何有效保护甲状旁腺，从而预防术后甲状旁腺功能减退或低下。方法 选取75例行甲状腺全切除术的病例，该病例术中均进行甲状旁腺保护，具体体现：①精细的手术解剖进行甲状旁腺术中识别和定位；②精确的甲状旁腺被膜解剖；③确切的保护甲状旁腺血供。术中及时发现甲状旁腺血供受损或被误切则行自体移植。观察术后近、远期有无低钙血症发生。结果 近期发生低钙血症38例（50.6%），予静脉补钙，最快5 d内出院前恢复正常，出院后继续口服葡萄糖酸钙和维生素D，最慢术后一月内恢复正常。术后随访1～5月，未出现远期低钙血症情况。结论 术中完整保护甲状旁腺，是避免甲状腺全切除手术后甲状旁腺功能减退最为有效的手段。行双侧Ⅵ区淋巴结清扫时，至少保留2个甲状旁腺，可有效防止术后永久性甲状旁腺功能低下的发生。

关键词：甲状腺全切除术；甲状旁腺；甲状旁腺功能低下；低钙血症

Abstract：Objective To explore how to effectively protect the parathyroid gland in total thyroidectomy，thus preventing postoperative hypoparathyroidism or low.Methods 75 cases of total thyroidectomy were selected.The patients were treated with parathyroid gland during operation. ①The fine anatomy was used to identify and locate the parathyroid surgery②Accurate parathyroid anatomy；③the exact protection of parathyroid blood supply.Intraoperative timely detection of parathyroid blood supply or was mistakenly autologous transplantation.Observation of postoperative near and long-term presence or absence of hypocalcemia.Results 38 cases（50.6%）of hypercalcemia occurred in the near future， intravenous calcium supplementation，the fastest 5 d returned to normal before discharge，after oral discharge of calcium gluconate and vitamin D，the fastest one month after the return to normal.The postoperative follow-up of 1 to 5 months，there is no long-term hypocalcemia.Conclusion Intraoperative protection of parathyroid gland is the most effective means to avoid hypothyroidism after total thyroidectomy.Line bilateral Ⅵ lymph node dissection，at least 2 to retain the parathyroid gland，which can effectively prevent the occurrence of postoperative permanent hypoparathyroidism.

Key words：Thyroidectomy；Parathyroid；Hypoparathyroidism；Hypocalcemia

甲狀旁腺功能减退或低下是甲状腺全切除术后最常见的严重并发症之一。尽管目前治疗方法有甲状旁腺腺瘤的同种异体移植、带血管蒂的异体甲状旁腺移植、自体甲状旁腺的胸锁乳突肌种植等[1-3]，但毫无疑问，术中仔细解剖、精细操作从而确切保护甲状旁腺是最直接、最有效的方法。甲状腺全叶切除术中，尤其是对于甲状腺癌患者行颈部淋巴结清扫时，易损伤或误切甲状旁腺。本研究共选取75例行甲状腺全叶切除病例，其中包括仪征市人民医院2014年4月～2015年7月20例，南京鼓楼医院2015年3月～7月55例。……