What Can I Expect During Parathyroid Surgery?

Parathyroidectomy is a surgical technique commonly used for parathyroid adenomas.

Parathyroidectomy

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Parathyroidectomy is a surgical technique commonly used for parathyroid adenomas.

Chinese name

Parathyroidectomy

Meaning

Surgical technique of parathyroid adenoma

Indication

Parathyroid adenoma, etc.

Preoperative preparation

Determination of blood calcium, urine calcium, phosphorus content, etc.

1. Parathyroid adenoma, which accounts for about 92% of hyperparathyroidism.

2. Parathyroid hyperplasia, accounting for 7%.

3. Parathyroid carcinoma, accounting for 1%.

1. Determination of blood calcium, urine calcium, phosphorus content and blood alkaline phosphatase content.

2. determination

Cervical plexus block or endotracheal anesthesia.

1. Posture and incision are the same as subtotal thyroidectomy.

2. The procedure of thyroid exposure is the same as that of subtotal thyroidectomy.

3. Examine the parathyroid glands

First, explore the normal locations of the four parathyroid glands. Start with the right lobe of the thyroid gland and cut off and ligate the right middle thyroid vein. Use a hemostatic forceps or a pull line to pull the thyroid inward and forward, bluntly separate the loose tissue on the right and left sides of the right lobe, and reach the esophagus and the cervical vertebral myometrium. In the distribution area, two parathyroid glands or adenomas were seen on the right. Normal parathyroid glands are orange-yellow, oval-shaped, about 5mm × 3mm × 2mm, with two on the left and one on the right. For example, one of the glands was reddish brown and swollen, mostly adenomas, which were easy to find. If more than two glands are larger than normal and the size is uneven, and the color is yellow-red-brown, it should be considered as hyperplasia. Most of the parathyroid carcinomas are round, grayish-white due to thickening of the capsule, and adhesions often occur with surrounding tissues. If no suspicious lesions or hyperplasia are found on the right side, continue to explore the left side.

Exploration of ectopic parathyroid adenoma: usually explored in three anatomical areas. A. neck thyroid region; B. sternal posterior region; C. upper mediastinal region, the thymus needs to be split to explore the thymus. It can also be searched through the mutation sites of the upper and lower parathyroid embryos. There are 4 abnormal sites in the upper parathyroid glands and 5 abnormal sites in the lower parathyroid glands. If no diseased glands can be found in the neck, the upper sternal bone should be split to explore the upper mediastinum or thymus. If necessary, the thymus can be removed and dissected to find the lesion. Because almost all parathyroid adenomas in the mediastinum are in the thymus.

4. Remove the parathyroid glands

Separate the enlarged adenoma from the surrounding tissue bluntly, cut off and ligate the incoming and outgoing blood vessels, and completely remove the adenoma.

Excision of hyperplasia of parathyroid glands: If more than two parathyroid glands are found to be enlarged, it can be judged as hyperplasia. After exploring four, select one of them to take part of the tissue to send frozen sections. When the pathology confirms hyperplasia, 3 can be removed, and only one para-gland not greater than 40 mg can be maintained to maintain normal function.

(3) If a diagnosis of parathyroid carcinoma is made, the ipsilateral thyroid lobe and isthmus and the anterior common carotid artery loose connective tissue, adipose tissue around the trachea, and lymph nodes should be resected together. If the cancer capsule is not ruptured, the recurrent laryngeal nerve can be retained. If the tumor has been ulcerated, or it has adhered to or infiltrated the recurrent laryngeal nerve, it should be removed at the same time.

5. Suture the anterior cervical muscle and skin incision and remove the parathyroid adenoma, and then close the wound reliably to stop bleeding. Without drainage, suture the incision. For parathyroid hyperplasia or adenocarcinoma, a wide range of operations and large wounds should be placed with a rubber sheet or a rubber tube for drainage. The method of incision suture is the same as that of subtotal thyroidectomy.

1. Hyperparathyroidism can be caused by adenoma, hyperplasia, or cancer with three different types of lesions, and the surgical methods vary. Therefore, it is necessary to search sequentially and regionally during the operation to find the diseased parathyroid glands. Frozen sections were taken quickly after finding, and corresponding surgical procedures were adopted according to the results of the pathological report.

2. It is sometimes not easy to find the parathyroid glands during surgery. You must be familiar with the normal anatomical parts of the parathyroid glands, as well as the possible mutation sites. You must look carefully and in order. If the lesion is not found in the normal position or in the neck area, the anterior mediastinum or thymus must be explored. The thymus can be gently and gradually separated from the sternum by the neck incision of the sternal stem, and finally the thymus is pulled out behind the sternum. If separation is difficult, the upper sternum can be split and the thymus can be explored or removed.

1. Within 1 to 3 days after operation, due to inadequate parathyroid function and hypocalcemia, hand and foot twitching may occur. Changes in blood calcium and phosphorus must be monitored, and 10% calcium chloride and oral vitamin D3 should be administered intravenously. If blood calcium is still low after 4 weeks, dihydrorapid sterols can be given.

2. Due to insufficient parathyroid hormone, urine volume should be paid attention to after operation. If the urine volume is too small or no urine, adequate intravenous infusion should be corrected.

3. Other local incision drainage, airway patency, prevention of infection is equivalent to subtotal thyroidectomy.