• 1.哈爾濱市第一醫(yī)院普外科(黑龍江哈爾濱 150001);;
  • 2.哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院整形科(黑龍江哈爾濱 150001);

目的  探討甲狀旁腺微血管解剖在甲狀腺囊內(nèi)切除術(shù)中的意義。
方法  以“甲狀旁腺微血管解剖、囊內(nèi)技術(shù)及保護(hù)”為關(guān)鍵詞進(jìn)行檢索,篩選近30年來的相關(guān)文獻(xiàn),就甲狀旁腺微血管解剖在甲狀腺囊內(nèi)切除術(shù)中的意義進(jìn)行綜述。
結(jié)果  甲狀旁腺血管的數(shù)量、起源、長(zhǎng)度和供應(yīng)方式有眾多情況,囊內(nèi)切除甲狀腺時(shí)應(yīng)采取針對(duì)性措施。
結(jié)論  充分認(rèn)識(shí)甲狀旁腺微血管解剖有助于運(yùn)用囊內(nèi)技術(shù)保護(hù)甲狀旁腺功能。

引用本文: 李文杰,徐海倩,翟立斌. 甲狀旁腺微血管解剖與甲狀腺囊內(nèi)切除技術(shù). 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(1): 104-107. doi: 復(fù)制

1. Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review[J]. World J Surg, 2008, 32(7): 1313-1324.
2. Bingham EL, Cheng SP, Woods Ignatoski KM, et al. Differentiation of human embryonic stem cells to a parathyroid-like phenotype[J]. Stem Cells Dev, 2009, 18(7): 1071-1080.
3. 郭偉, 譚介恒. 甲狀腺手術(shù)中甲狀旁腺損傷的原因及預(yù)防[J]. 廣西醫(yī)科大學(xué)學(xué)報(bào), 2009, 26(3): 471-472.
4. 黃韜. 甲狀旁腺術(shù)中損傷的預(yù)防和處理[J]. 中國(guó)實(shí)用外科雜志, 2008, 28(3): 179-180.
5. 閆利英, 李隨勤, 張少?gòu)?qiáng), 等. 甲狀腺全切及近全切術(shù)中甲狀旁腺的原位保護(hù)[J]. 臨床耳鼻咽喉科雜志, 2006, 20(21): 980-982.
6. 吳在德, 吳肇漢. 外科學(xué)[M]. 第6版. 北京: 人民衛(wèi)生出版社, 2003: 316-317.
7. Akerström G, Malmaeus J, Bergström R. Surgical anatomy of human parathyroid glands[J]. Surgery, 1984, 95(1): 14-21.
8. 湯釗猷. 現(xiàn)代腫瘤學(xué)[M]. 第2版. 上海: 復(fù)旦大學(xué)出版社, 2000: 1090-1091.
9. 陳孝平. 外科學(xué)[M]. 北京: 人民衛(wèi)生出版社, 2005: 429-430.
10. Cavicchi O, Piccin O, Caliceti U, et al. Accuracy of PTH assay and corrected calcium in early prediction of hypoparathyroidism after thyroid surgery[J]. Otolaryngol Head Neck Surg, 2008, 138(5): 594-600.
11. Halsted WS, Evans HM. The parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gland[J]. Ann Surg, 1907, 46(4): 489-506.
12. Thompson NW, Olsen WR, Hoffman GL. The continuing development of the technique of thyroidectomy[J]. Surgery, 1973, 73(6): 913-927.
13. Attie JN, Khafif RA. Preservation of parathyroid glands during total thyroidectomy. Improved technic utilizing microsurgery[J]. Am J Surg, 1975, 130(4): 399-404.
14. 邵選, 潘永海, 吳成亮, 等. 精細(xì)被膜解剖法原位保留甲狀旁腺的臨床應(yīng)用[J]. 實(shí)用醫(yī)學(xué)雜志, 2009, 25(13): 2110-2111.
15. Geis NP. The parathyroid glands[J]. Ann Surg, 1908, 47(4): 523-531.
16. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique[J]. World J Surg, 2000, 24(8), 891-897.
17. 方向, 陳玉祥, 李俊, 等. 甲狀腺手術(shù)時(shí)保護(hù)甲狀旁腺的方法研究[J]. 醫(yī)學(xué)信息 (下旬刊), 2011, 24(8): 54-55.
18. David C, Sabiston Jr. 克氏外科學(xué)[M]. 第18版. 西安: 世界圖書出版公司, 2007: 361-362.
19. Proye C, Patoir A, Trincaretto F, et al. Advantages of systematic recurrent laryngeal nerve resection during thyroid surgery. Results of 422 thyroidectomies employing this procedure[J]. J Chir (Paris), 1980, 117(3): 155-160.
20. Gouillat C, Bouchet A, Soustelle J. The parathyroid risk in thyroid surgery[J]. J Chir (Paris), 1979, 116(8-9): 505-512.
21. Flament JB, Delattre JF, Pluot M. Arterial blood supply to the parathyroid glands: implications for thyroid surgery[J]. Anat Clin, 1982, 3: 279-287.
22. 陳世彩, 鄭宏良, 周水淼 ,等. 甲狀腺手術(shù)喉返神經(jīng)損傷規(guī)律及治療的探討[J]. 中華耳鼻咽喉科雜志, 2004, 39(8): 464-468.
23. Li ZB, Lehar M, Samlan R, et al. Proteomic analysis of ratlaryngeal muscle following denervation[J]. Proteomics, 2005, 5(18): 4764-4776.
24. Johansson K, Ander S, Lennquist S, et al. Human parathyroid blood supply determined by laser-Doppler flowmetry[J]. World J Surg, 1994, 18(3): 417-420.
25. Nobori M, Saiki S, Tanaka N, et al. Blood supply of the parathyroid gland from the superior thyroid artery[J]. Surgery, 1994, 115(4): 417-423.
26. Monchick JM, Doppman JL, Earll JM, et al. Localization of hyperfunctioning parathyroid tissue. Radioimmunoassay of parathyroid hormone on samples from the large veins of the neck and thorax and selectively catheterized thyroid veins[J]. Am J Surg, 1975, 129(4): 413-420.
27. 朱士興, 姚懷龍. 囊內(nèi)結(jié)扎甲狀腺動(dòng)脈分支在甲狀腺手術(shù)后的功能保全的作用[J]. 實(shí)用預(yù)防醫(yī)學(xué), 2011, 18(2): 314-316.
28. Ellis H. Anatomy of the thyroid and parathyroid glands[J]. Surgery, 2007, 25(11): 467-468.
29. 吳高松, 馬小鵬, 劉捷, 等. 甲狀旁腺原位保護(hù)技術(shù)在甲狀腺全切除術(shù)中的應(yīng)用[J]. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(2): 120-123.
30. 李振東, 劉宏偉, 董慧蕾, 等. 甲狀腺全切除術(shù)中甲狀旁腺及其功能的保護(hù)[J]. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(11): 809-903.
31. Cocchiara G, Cajozzo M, Amato G, et al. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels[J]. J Visc Surg, 2010, 147(5): e329-e332.
32. Lo CY, Lam KY. Routine parathyroid autotransplantation during thyroidectomy[J]. Surgery, 2001, 129(3): 318-323.
33. 呂新生, 李新營(yíng), 王志明, 等. 甲狀腺手術(shù)所致喉返神經(jīng)損傷的手術(shù)治療[J]. 中華外科雜志, 2005, 43(5): 301-303.
34. 李新營(yíng), 呂新生, 王志明, 等. 外科手術(shù)治療甲狀腺手術(shù)所致喉返神經(jīng)損傷[J]. 中國(guó)普通外科雜志, 2007, 16(11): 1037-1040.
35. 程若川, 艾楊卿, 刁暢, 等. 甲狀腺手術(shù)中甲狀旁腺顯露及功能保護(hù)的臨床研究[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(5): 351-355.
36. 高興強(qiáng), 趙德安, 駱獻(xiàn)陽, 等. 保留甲狀腺上下動(dòng)脈預(yù)防甲狀旁腺功能低下的術(shù)式探討[J]. 臨床耳鼻咽喉頭頸外科雜志, 2009, 23(18): 854.
37. Nanka O, Libánsky P, Sedý J,et al. Surgical-anatomical study as a part of operative treatment of primary hyperparathyroidism[J]. Rozhl Chir, 2006, 85(12): 618-623.
38. 柳挺, 尹金鵬. 甲狀旁腺及其血供的解剖學(xué)應(yīng)用[J]. 中國(guó)社區(qū)醫(yī)師 (醫(yī)學(xué)專業(yè)), 2011, 13(9): 124-125.
  1. 1. Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review[J]. World J Surg, 2008, 32(7): 1313-1324.
  2. 2. Bingham EL, Cheng SP, Woods Ignatoski KM, et al. Differentiation of human embryonic stem cells to a parathyroid-like phenotype[J]. Stem Cells Dev, 2009, 18(7): 1071-1080.
  3. 3. 郭偉, 譚介恒. 甲狀腺手術(shù)中甲狀旁腺損傷的原因及預(yù)防[J]. 廣西醫(yī)科大學(xué)學(xué)報(bào), 2009, 26(3): 471-472.
  4. 4. 黃韜. 甲狀旁腺術(shù)中損傷的預(yù)防和處理[J]. 中國(guó)實(shí)用外科雜志, 2008, 28(3): 179-180.
  5. 5. 閆利英, 李隨勤, 張少?gòu)?qiáng), 等. 甲狀腺全切及近全切術(shù)中甲狀旁腺的原位保護(hù)[J]. 臨床耳鼻咽喉科雜志, 2006, 20(21): 980-982.
  6. 6. 吳在德, 吳肇漢. 外科學(xué)[M]. 第6版. 北京: 人民衛(wèi)生出版社, 2003: 316-317.
  7. 7. Akerström G, Malmaeus J, Bergström R. Surgical anatomy of human parathyroid glands[J]. Surgery, 1984, 95(1): 14-21.
  8. 8. 湯釗猷. 現(xiàn)代腫瘤學(xué)[M]. 第2版. 上海: 復(fù)旦大學(xué)出版社, 2000: 1090-1091.
  9. 9. 陳孝平. 外科學(xué)[M]. 北京: 人民衛(wèi)生出版社, 2005: 429-430.
  10. 10. Cavicchi O, Piccin O, Caliceti U, et al. Accuracy of PTH assay and corrected calcium in early prediction of hypoparathyroidism after thyroid surgery[J]. Otolaryngol Head Neck Surg, 2008, 138(5): 594-600.
  11. 11. Halsted WS, Evans HM. The parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gland[J]. Ann Surg, 1907, 46(4): 489-506.
  12. 12. Thompson NW, Olsen WR, Hoffman GL. The continuing development of the technique of thyroidectomy[J]. Surgery, 1973, 73(6): 913-927.
  13. 13. Attie JN, Khafif RA. Preservation of parathyroid glands during total thyroidectomy. Improved technic utilizing microsurgery[J]. Am J Surg, 1975, 130(4): 399-404.
  14. 14. 邵選, 潘永海, 吳成亮, 等. 精細(xì)被膜解剖法原位保留甲狀旁腺的臨床應(yīng)用[J]. 實(shí)用醫(yī)學(xué)雜志, 2009, 25(13): 2110-2111.
  15. 15. Geis NP. The parathyroid glands[J]. Ann Surg, 1908, 47(4): 523-531.
  16. 16. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique[J]. World J Surg, 2000, 24(8), 891-897.
  17. 17. 方向, 陳玉祥, 李俊, 等. 甲狀腺手術(shù)時(shí)保護(hù)甲狀旁腺的方法研究[J]. 醫(yī)學(xué)信息 (下旬刊), 2011, 24(8): 54-55.
  18. 18. David C, Sabiston Jr. 克氏外科學(xué)[M]. 第18版. 西安: 世界圖書出版公司, 2007: 361-362.
  19. 19. Proye C, Patoir A, Trincaretto F, et al. Advantages of systematic recurrent laryngeal nerve resection during thyroid surgery. Results of 422 thyroidectomies employing this procedure[J]. J Chir (Paris), 1980, 117(3): 155-160.
  20. 20. Gouillat C, Bouchet A, Soustelle J. The parathyroid risk in thyroid surgery[J]. J Chir (Paris), 1979, 116(8-9): 505-512.
  21. 21. Flament JB, Delattre JF, Pluot M. Arterial blood supply to the parathyroid glands: implications for thyroid surgery[J]. Anat Clin, 1982, 3: 279-287.
  22. 22. 陳世彩, 鄭宏良, 周水淼 ,等. 甲狀腺手術(shù)喉返神經(jīng)損傷規(guī)律及治療的探討[J]. 中華耳鼻咽喉科雜志, 2004, 39(8): 464-468.
  23. 23. Li ZB, Lehar M, Samlan R, et al. Proteomic analysis of ratlaryngeal muscle following denervation[J]. Proteomics, 2005, 5(18): 4764-4776.
  24. 24. Johansson K, Ander S, Lennquist S, et al. Human parathyroid blood supply determined by laser-Doppler flowmetry[J]. World J Surg, 1994, 18(3): 417-420.
  25. 25. Nobori M, Saiki S, Tanaka N, et al. Blood supply of the parathyroid gland from the superior thyroid artery[J]. Surgery, 1994, 115(4): 417-423.
  26. 26. Monchick JM, Doppman JL, Earll JM, et al. Localization of hyperfunctioning parathyroid tissue. Radioimmunoassay of parathyroid hormone on samples from the large veins of the neck and thorax and selectively catheterized thyroid veins[J]. Am J Surg, 1975, 129(4): 413-420.
  27. 27. 朱士興, 姚懷龍. 囊內(nèi)結(jié)扎甲狀腺動(dòng)脈分支在甲狀腺手術(shù)后的功能保全的作用[J]. 實(shí)用預(yù)防醫(yī)學(xué), 2011, 18(2): 314-316.
  28. 28. Ellis H. Anatomy of the thyroid and parathyroid glands[J]. Surgery, 2007, 25(11): 467-468.
  29. 29. 吳高松, 馬小鵬, 劉捷, 等. 甲狀旁腺原位保護(hù)技術(shù)在甲狀腺全切除術(shù)中的應(yīng)用[J]. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(2): 120-123.
  30. 30. 李振東, 劉宏偉, 董慧蕾, 等. 甲狀腺全切除術(shù)中甲狀旁腺及其功能的保護(hù)[J]. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(11): 809-903.
  31. 31. Cocchiara G, Cajozzo M, Amato G, et al. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels[J]. J Visc Surg, 2010, 147(5): e329-e332.
  32. 32. Lo CY, Lam KY. Routine parathyroid autotransplantation during thyroidectomy[J]. Surgery, 2001, 129(3): 318-323.
  33. 33. 呂新生, 李新營(yíng), 王志明, 等. 甲狀腺手術(shù)所致喉返神經(jīng)損傷的手術(shù)治療[J]. 中華外科雜志, 2005, 43(5): 301-303.
  34. 34. 李新營(yíng), 呂新生, 王志明, 等. 外科手術(shù)治療甲狀腺手術(shù)所致喉返神經(jīng)損傷[J]. 中國(guó)普通外科雜志, 2007, 16(11): 1037-1040.
  35. 35. 程若川, 艾楊卿, 刁暢, 等. 甲狀腺手術(shù)中甲狀旁腺顯露及功能保護(hù)的臨床研究[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(5): 351-355.
  36. 36. 高興強(qiáng), 趙德安, 駱獻(xiàn)陽, 等. 保留甲狀腺上下動(dòng)脈預(yù)防甲狀旁腺功能低下的術(shù)式探討[J]. 臨床耳鼻咽喉頭頸外科雜志, 2009, 23(18): 854.
  37. 37. Nanka O, Libánsky P, Sedý J,et al. Surgical-anatomical study as a part of operative treatment of primary hyperparathyroidism[J]. Rozhl Chir, 2006, 85(12): 618-623.
  38. 38. 柳挺, 尹金鵬. 甲狀旁腺及其血供的解剖學(xué)應(yīng)用[J]. 中國(guó)社區(qū)醫(yī)師 (醫(yī)學(xué)專業(yè)), 2011, 13(9): 124-125.