Tider方法在手术治疗继发性甲状旁腺功能亢进中的应用

doi:10.16139/j.1007-9610.2020.03.012

摘要/Abstract

摘要：

目的:优化甲状旁腺切除术（parathyroidectomy, PTX）治疗继发性甲状旁腺功能亢进（secondary hyperparathyroidism, SHPT）的方法。方法:将PTX术中的示踪显影（tracing/imaging）、分离（dissection）、探查（exploration）、切除（resection）4项整合为Tider方法。甲状腺注射纳米炭示踪显影,分离颈部组织,达到所需解剖界限,视、触双诊探查定位甲状旁腺,切除甲状旁腺时尽可能切除周围可疑组织。2018年3月后应用于25例SHPT病人（Tider组）;回顾性对比2015年3月至2018年12月未应用Tider方法的34例SHPT病人（对照组）,比较两组手术时间、手术成功率及术后第1天PTH水平。结果:Tider组中22例行甲状旁腺全切除术,3例行甲状旁腺全切除+旁腺自体移植术。共切除101枚甲状旁腺,切除甲状旁腺最大径为（1.56±0.63） cm（左上）、（1.66±0.53） cm（左下）、（1.51±0.56） cm（右上）和（1.72±0.76） cm（右下）。两组手术时间60~150 min,Tider组手术时间明显少于对照组[（82.8±9.5) min比（98.5±20.4） min,P=0.001]。除对照组1例出现拔管后窒息外,两组均无出血、喉返神经损伤、严重低钙血症等围术期并发症发生。Tider组手术均获成功,术后第1天PTH为（22.9±10.3） ng/L,均<65 ng/L。对照组有6例手术失败,术后第1天PTH为（112.3±239.6）（7.7~1 216.0） ng/L。对照组手术成功率为82.4%,两组差异无统计学意义（P=0.075）。结论:Tider方法缩短PTX手术时间,规范手术操作流程,保证手术成功率。

关键词: 继发性甲状旁腺功能亢进, 甲状旁腺切除术, Tider方法

Abstract:

Objective To optimize the operative process of parathyroidectomy (PTX) for the treatment of secondary hyperparathyroidism (SHPT). Methods Four approaches including tracing/imaging, dissection, exploration, and resection were integrated into Tider process. Nano-carbon particles were used to inject into thyroid glands for imaging and separation of cervical tissue was performed with specific vision of anatomic landmarks. Parathyroid glands were thoroughly revealed by standard exploration using inspection and palpation. Resection of parathyroids should involve the surrounding tissue as more as possible. This Tider process was used into PTX for 25 patients with SHPT in Tider group since March 2018. Thirty-four patients with SHPT without use of Tider process were in control group from March 2015 to December 2018. Outcomes including operative time, operative success rate and PTH at the postoperative first day were compared between Tider group and control group. Results Total PTX and total PTX with auto-transplantation in Tider group were all done successfully in 22 cases and 3 cases, respectively. A total of 101 parathyroid were resected with maximum diameter (1.56±0.63) cm of left superior gland, (1.66±0.53) cm of left inferior gland, (1.51±0.56) cm of right superior gland, and (1.72±0.76) cm of right inferior gland. Operative time ranged from 60 to 150 min with less time [(82.8±9.5) min] in Tider group than that [(98.5±20.4) min] in control group significantly (P=0.001). No operative complications such as bleeding, recurrent laryngeal nerve injury and severe hypocalcemia were found in both groups except one case died due to suffocation after tracheal extubation in control group. PTH in Tider group was (22.9±10.3) ng/L (<65 ng/L) at the postoperative first day. However, operation failed 6 cases in control group with PTH (112.3±239.6) (7.7~1 216.0) ng/L at the postoperative first day. Operative success in control group was 82.4% with no difference in success rate between 2 groups (P=0.075). Conclusions Tider process could be useful in PTX procedure with less operative time, more standardization and successful operation.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Tider process

中图分类号:

R653

单成祥, 李伟, 刘冰洋, 王强, 饶文胜, 查斯洛, 仇明, 张伟. Tider方法在手术治疗继发性甲状旁腺功能亢进中的应用[J]. 外科理论与实践, 2020, 25(03): 234-238.

SHAN Chengxiang, LI Wei, LIU Bingyang, WANG Qiang, RAO WenSheng, ZHA Siluo, QIU Ming, ZHANG Wei. Application of Tider process in parathyroidectomy for treatment of secondary hyperparathyroidism[J]. Journal of Surgery Concepts & Practice, 2020, 25(03): 234-238.

图/表 2

参考文献 11

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组别	性别（男/女）	年龄（岁）	透析时间 (年)	PTH(ng/L)	血钙(mmol/L)	血磷(mmol/L)
Tider组(n=25)	12/13	50.9±10.9	7.4±2.3	1 834.1±914.8	2.5±0.2	2.6±0.7
对照组(n=34)	15/19	48.7±12.6	7.2±3.8	1 772.0±954.4	2.5±0.2	2.5±0.2
t值		0.707	0.215	0.251	-0.369	0.429
χ²值	0.087
P值	0.767	0.483	0.830	0.803	0.714	0.669

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