갑상선절제술 중 부갑상선저하증 예방을 위한 혈관보존

삼성서울병원 갑상선외과에서 쓴 논문으로 2016년에 World Journal of Surgery에 accept가 된 논문입니다. 작업은 2015년에 했던 것 같습니다. 논문의 내용이 매우 전문적인데다가 여러 번의 수정을 거치면서 제 이름 Jinsoo Rhu도 논문에 실리게 되었습니다.

Figure 1은 갑상선 절제술 (thyroidectomy)를 하는 중에 갑상선 뒤에 위치한 부갑상선이 함께 제거되거나 혈류를 상실해서 허혈로 인해 보존되지 못하는데 이를 살리기 위해서 혈관들을 어떻게 다루어야 하는지 설명하는 그림입니다. A부터 G까지 이런 경우에는 이렇게 한다, 식의 서술을 하고 있습니다.

메디컬 일러스트의 중요성은 Figure 2를 보면 더 강조됩니다. 사진에서 아주 작은 혈관이 부갑상선으로 들어가고 있다는 것을 설명하고 있지만, 저 정도 사진을 이해하는 것은 전문가도 쉽지 않습니다. 이런 경우에 아주 심플하게 쓱쓱 그린 일러스트가 도움이 되는 것입니다.

BACKGROUND:

The failure to preserve parathyroid function in patients who have undergone total thyroidectomy is of major concern, because hypocalcemia is difficult to prevent and remains a common postoperative complication. Here, we describe procedures designed to preserve the vasculature supplying the parathyroid glands and examine both recent outcomes and retrospective reports of results obtained prior to the application of these preservation techniques.

METHODS:

Our technique for preserving parathyroid function during thyroidectomy was adopted in 2009 and involves separating a relatively long segment of a vessel distally from the thyroid gland. We reviewed the medical records of 1,411 patients who underwent total thyroidectomy, with or without lateral neck dissection, at the Samsung Medical Center from January 2006 through June 2014 to determine outcomes. Patients were divided into three groups according to the time period during which the surgery took place: Group A, 2006-2008 (before the vasculature-preserving technique was applied); Group B, 2009-2011 (the time when the technique was first adopted); and Group C, 2012-2014 (more recent results of the technique). We analyzed the incidence of hypoparathyroidism in the three groups, as well as risk factors that influenced its development.

RESULTS:

The rates of transient and permanent hypoparathyroidism in Group A were 25.4 and 4.3 %, respectively. However, the incidence of hypoparathyroidism decreased significantly over time after the vasculature-preserving procedure was adopted. Transient hypoparathyroidism developed in 4.8 % of Group C patients, and only four (0.7 %) of the 565 patients in this group required calcium supplementation, despite the fact that a greater number of patients were included who underwent total thyroidectomy combined with lateral neck dissection. Although female sex and lateral neck dissection tended to increase the rate of transient hypoparathyroidism, multivariate analysis showed that the vasculature-preserving procedure was the only significant risk factor related to postoperative hypoparathyroidism.

CONCLUSION:

The blood flow of the final branch to the parathyroid gland is mostly in the lateral-to-medial direction; therefore, mobilization and preservation of the vessels lateral to the gland is essential to prevent devascularization of the parathyroid gland.

http://link.springer.com/article/10.1007%2Fs00268-016-3423-3