What Should I Do after a Parathyroidectomy?

Parathyroidectomy is a disease surgery for parathyroid hyperplasia. Parathyroidectomy is suitable for hyperparathyroidism: the parathyroid glands secrete too much parathyroid hormone, which leads to an increase in blood calcium, causing a series of symptoms: muscle spasms or convulsions, fragile bones (osteoporosis), Nephropathy (including kidney stones), mental problems (depression, irritability, fatigue, anxiety), as well as abdominal pain, nausea, and vomiting.

Parathyroidectomy

Indications 1. Primary hyperparathyroidism (approximately 80%), parathyroid hyperplasia, parathyroid carcinoma (approximately 1 %about). 2. chronic

[Indications]

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

2. Parathyroid hyperplasia, accounting for 7%.

3. Parathyroid carcinoma, accounting for 1%.

[Preoperative preparation]

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

2. Measure renal function and check for urinary tract stones.

3. Take X-rays to check the bone decalcification. If there are changes in osteoporosis and decalcification, the patient should be instructed to rest in bed to avoid pathological fractures.

4. Do B-mode and CT examinations, if necessary, perform superior mediastinal inflation imaging or subclavian arteriography to determine the tumor location.

[anesthesia]

Cervical plexus block or endotracheal anesthesia.

[Surgery steps]

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

4. Remove the parathyroid glands

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.

[Intraoperative precautions]

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.

[Postoperative treatment]

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 intravenous injection of 10% calcium chloride and oral vitamin D3. 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.