Effects of different type of parathyroid damage to the postoperative functional recovery of parathyroid during thyroid operation / 国际外科学杂志

ABSTRACT

Objective To study the effects of different type of parathyroid damage to the postoperative functional recovery of parathyroid,through establish an animal model by simulating total thyroidectomy and parathyroid damage during surgical operation.Methods Experimental rabbits for the study were randomly divided into A,B,C,D four groups (n =8),Group A (control group)simple exposure,exploration thyroid and parathyroid;group B (vascular injury group)total thyroidectomy and ligation bilateral parathyroid blood supply but keep the surrounding membrane;Group C (membrane damage group)total thyroidectomy and damage membrane but reservations blood supply.Group D (composite damage group)total thyroidectomy plus membrane and blood both damage;All animals were monitored of serum calcium and PTH,preoperative 1 days and postoperative 1 st day,3rd day,5th day,7t day;cut the parathyroid HE staining to observed survival of parathyroid tissue and pathology damage when 7th day after operation.Results (1) Animals in each group preoperative serum calcium and PTH were no significant difference (P ＞0.05);(2)Group A postoperative serum calcium decreased,but at 5th day returned to preoperative level (P ＞ 0.05);Group B and C postoperative 1st day,3rd day,5th day serum calcium decreased significantly(P ＜ 0.05)and to the lowest at 1 d and then gradually recovered,but group C faster recovered than group B (P ＜ 0.05);Group D postoperative 1 st day,3rd day serum calcium continued to decline significantly (P ＜ 0.05);(3) Group A postoperative serum PTH decreased,but at 7th days returned to preoperative level (P ＞ 0.05).Group B and C postoperative 1st day,3rd day,5th days serum PTH decreased significantly(P ＜0.05)and to the lowest at 1 d and then gradually recovered,but from postoperative 3rd day group C faster recovered than group B(P ＜ 0.05);Group D postoperative 1 st day,3rd day serum PTH continued to decline significantly (P ＜ O.05);(4) Pathology results:Group A parathyroid filled with chief cells and a small amount of vacuolar changes (5％ to 10％);Group B parathyroid hemorrhage,necrosis (40％ to 50％),part of the cell degeneration (30％ to 40％),center with fibrosis,seen granuloma and hyperplasia of parathyroid tissue in surrounding;Group C parathyroid bleeding (10％ to 20％),part of the cell degeneration (10％ to 20％);Group D parathyroid severe necrosis,almost no normal parathyroid tissue,significant fibrosis,less residual parathyroid tissue was scattered.Conclusions (l) The recover of Parathyroid function is influenced by the type of parathyroid in situ injury during thyroidectomy,composite damage of blood supply and membrane of parathyroid is the most serious,parathyroid ischemia necrosis,the function can not be restored,pure blood supply damaged,some can restore function,and the parathyroid gland with vascular pedicle can be recovered quickly.(2) Severe blood supply and membrane damaged,and even free parathyroid should be transplanted immediately during operation.