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題名 | 甲狀腺全切除時之副甲狀腺自體移植=Parathyroid Autotransplantation in Total Thyroidectomy |
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作者姓名(中文) | 江豐裕; 阮愷輝; | 書刊名 | 中華民國耳鼻喉科醫學會雜誌 |
卷期 | 32:1 1997.02[民86.02] |
頁次 | 頁52-57 |
分類號 | 416.213 |
關鍵詞 | 甲狀腺全切除; 副甲狀腺自體移植; 低鈣血症; Total thyroidectomy; Parathyroid autotransplantation; Hypocalcemia; |
語文 | 中文(Chinese) |
中文摘要 | 從民國78年1月至84年12月間本院耳鼻喉科共施行了470例甲狀腺手術,本研究限 於病人接受甲狀腺全切除且為同一術者的 107 例, 其中 40 例為甲狀腺癌、29 例 Graves 氏病、29 例多發性甲狀腺結節、2 例慢性甲狀腺炎、另 7 例為較嚴重的下咽喉癌。術後 5 例( 4.7 %)發生永久性低鈣血症,47 例( 44 %)發生暫時性低鈣血症,暫時性低鈣血 症的時間從 3 到 63 天(平均 17 天), 另 55 例( 51.3 %)血鈣離子都在正常範圍內 。 在 5 例發生永久性低鈣血症的病人中 2 例為甲狀腺癌、3 例為 Graves 氏病; 其中 3 例接受 1 顆副甲狀腺自體移植、1 例接受 2 顆、另 1 例接受 4 顆副甲狀腺自體移植。綜 合文獻記載和我們的經驗, 建議使用以下方法以避免永久性及暫時性低鈣血症的發生: 1. 手術中不刻意尋找下副甲狀腺,手術時沿著甲狀腺包膜剝離以防止下副甲狀腺被拿走;2.綁 血管時盡量靠近甲狀腺以保留下副甲狀腺的供應血管; 3. 上副甲狀腺由於血管供應較不穩 定,所以我們建議必需找出來並施行自體移植; 4. 副甲狀腺若已失去血液供應時應盡速種 植,且切成的薄片應愈小愈好; 5. 在接受移植片的地方要避免流血,血腫易造成移植片的 壞死;6. 若有兩顆副甲狀腺需種植,最好分別種植於兩處;7. 若胸鎖乳突肌因兩側頸廓清 術而造成血液供應不良,此時副甲狀腺可考慮種植於胸大肌。(中耳醫誌 1997;32:52-57。 ) |
英文摘要 | From 1989 through 1995, 470 patients received different types of thyroidectomy at our department. Out study was confined to those 107 patients who had received total thyroidectomies and performed by the same surgeon during this period. The 107 cases were distributed as follows: 40 cases were thyroid cancer, 29 Graves' disease, 29 multi-nodular goiter, 2 chronic thyroiditis, and 7 advanced laryngopharyngeal cancer. Postoperatively, 5 of 107 patients ( 4.7 %) developed permanent hypocalcemia. Temporary hypocalcemia was found in 47 patients ( 44 %),with a recovery period between 3 and 63 days (average, 17 days). Free calcium level was normal in 55 patients ( 51.3 %).In the 5 patients with permanent hypocalcemia, three patients were with one parathyroid gland autotransplanted, one with two glands and one with four glands. According to the results of this study and the previous reports, we sugested that permanent and temporary hypocalcemia can be avoided as follows: 1. by keping the plane of dissection on the capsule of the thyroid gland to prevent removal of the inferior parathyroid glands with the specimen; 2. by ligating vessel close to the thyroid gland to preserve vascular supply to the inferior parathyroids; 3. by identifying the superior parathyroid glands and reimplanting them; 4. the devascularized parathyroid glands should be transplanted as soon as possible and in the smallest possible section; 5. bleeding in the implantation site should be carefully avoided; 6. if two parathyroid glands would be implsnted, two implantation sites should be made; and 7. pectoralis major muscle is a preferred implantation site in the preferred implantation site in the patients with bilateral lymph node dissections. |
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