[Clinical and anatomic study of preserving parathyroid specific adipose attachments in total thyroidectomy]

Objective: To discuss the anatomical characteristic and important role of specific adipose attachments in preserving parathyroid function in total thyroidectomy. Methods: Parathyroid glands of 91 cases underwent total thyroidectomy in Department of General Surgery, Beijing Hospital from January to November 2015 were observed prospectively. There were 19 male and 72 female patients, aging from 25 to 74 years with an average age of (52±12) years. Preoperative ultrasound examination, analysis of intraoperative high definition images, and postoperative pathological examination were used to detect the origins of the parathyroid micro vascular structures and the characteristics of parathyroid specific adipose attachments. Parathyroid specific adipose attachments preserving technique was used in all procedures. The results of parathyroid hormone (PTH), serum calcium and phosphorus were compared pre- and 1-month post-operatively. Paired t test was statistically used to analyze data. Results: Parathyroid micro vascular vessels were closely attached to parathyroid, and they were mainly originated from inside and (or) outside thyroid. Twenty patients received intraoperative high definition images analysis, 62 parathyroids were detected, in which 48 parathyroids (77.4%) had its specific adipose attachments. Lymphatic tissues could be distinguished from adipose tissue using carbon nanoparticles lymphatic tracer technique, which resulted in better preservation of parathyroid specific adipose attachments. There was no significant difference in PTH ((39±17) ng/L vs. (30±16) ng/L), serum calcium ((2.23±0.10) mmol/L vs. (2.20±0.14) mmol/L) and phosphorus ((1.27±0.20) mmol/L vs.(1.26±0.25) mmol/L) pre- and 1-month post-operatively (P>0.05). Conclusions: Preservation of parathyroid specific adipose attachments in total thyroidectomy could result in better protection of parathyroid micro vascular structure and function. It could be benefit to preservation of parathyroid in situ and its function recovery, thus may reduce the incidence of permanent postoperative hypoparathyroidism.