Application Of Exposure And Protection Of Parathyroid Glands In Situ During The Differentiated Thyroid Cancer Surgery

Objective:To discuss the method and effect of exposing and protecting the parathyroid glands in differentiated thyroid cancer surgery assisted with magnifying glass, and summarize the reasons and countermeasures of postoperative hypoparathyroidism and hypocalcemia.Method:150patients of differentiated thyroid cancer were operated during2010-2012in the Fourth Central Hospital of Tianjin for the first time. They were randomly divided into A, B groups. According to the tumor extent and risk factors, group A of75patients was subdivided into group Al of70cases:accepted operation1:unilateral lobectomy and isthmic resection plus unilateral level VI lymphadenectomy, group A2of80cases:accepted operation2:total/near-total thyroidectomy plus bilateral level VI lymphadenectomy. The back capsule of thyroid was reserved and the PTGs were not looking for in two procedures. Group B of150patients was divided into group B1of75cases:accepted operation1:unilateral lobectomy and isthmic resection plus unilateral VI. group B2of75cases:accepted operation2:total/near-total thyroidectomy plus bilateral level VI lymphadenectomy.The PTGs were exposed and protected in situ, and their blood supply was reserved by meticulous capsular dissection with magnifying glass. To detect serum calcium and PTH at preoperative and postoperative1st.2nd,3rd,7th,14th days,1month, to observe clinical manifestations of hypocalcemia. lymph nodes of level VI lymphadenectomy. the situation of inadvertent parathyroidectomy.1-year short-term recurrence rate in each group and to compare the groups.Result:1. The incidence of temporary hypoparathyroidism was17.3%(9/52).56.5%(13/23) in group Al, A2. Group A2had three cases of permanent hypoparathyroidism. and the ratio was13.0%(3/23). The incidence of temporary hypoparathyroidism was10.9%(6/55),35%(7/20)in group B1, B2. All patients in group B did not have permanent hypoparathyroidism.2. In group B2of exposing and protecting the PTGs in situ assisted with magnifying glass, the postoperative incidence of parathyroid dysfunction and hypocalcemia was significantly lower than group A2without finding PTGs (P <0.05).3. In operation1, group B was lower than group A in the decline of postoperative serum calcium and PTH, but there was no significant difference between group A and B in the recovery time (P>0.05). In operation2, group B was lower than group A in the decline of postoperative serum calcium and PTH. and quicker in the recovery time, the difference was statistically significant (P<0.05).4. Under the same surgical operation, there were no significant differences in average number of level VI lymphadenectomy and1-year short-term recurrence rate between groupA and B (P>0.05). But the rate of inadvertent parathyroidectomy(IPE) was different.(P<0.05).5. Comparison between the same group, with the increasing extent of resection. the incidence of hypoparathyroidism and hypocalcemia increased, the difference was significant (P<0.05).Conclusion:1. Differentiated thyroid cancer surgery often complicated by postoperative transient hypoparathyroidism and hypocalcemia. With resection increasing, especially total thyroidectomy plus bilateral level VI lymphadenectomy. the probability of parathyroid injure increases, and parathyroid function may be permanently reduced.2. In differentiated thyroid cancer surgery, the application of magnifying glass to expose and protect the parathyroid in situ. which can effectively reduce the rate of inadvertent parathyroidectomy. reduce the incidence of hypoparathyroidism and hypocalcemia, this method does not affect level VI lymphadenectomy effects and short-term prognosis. especially in total thyroidectomy. It is conducive to the recovery of postoperative parathyroid function, relatively safe and feasible.3. The lowest serum calcium often appears in the second day after surgery, the majority is going to recover after1month. We should conventionally detect calcium and PTH in the first three days after surgery, according to the condition to give calcium for promoting parathyroid function recovery, which can effectively reduce the physical and psychological impact of hypocalcemia in patients.4. The key to prevention of postoperative hypoparathyroidism is familiar with the anatomical characteristics of the PTG and the PTGs should be protected in situ through meticulous dissection without injuring their blood supply, or autotransplant the jeopardized parathyroid glands in necessary.