目的：探讨精细化被膜解剖法在分化型甲状腺癌手术中的应用价值。方法：回顾2011年3月—2015年3月75例行全甲状腺切除+中央组淋巴结清扫术的分化型甲状腺癌患者资料，患者均采用精细化被膜解剖法对甲状旁腺的识别与原位保留，对于严重缺血或误切的甲状旁腺，术中及时进行自体移植。结果：75例患者中，46例术中确认并原位保留甲状旁腺4枚，其余原位保留2~3枚。手术后12 h，部分患者出现口角及手足麻木、轻度抽搐，无1例患者出现呼吸困难、休克等严重并发症；术后1个月，血清钙<2.0 mmol/L 18例，术后2~3个月，血清钙<2.0 mmol/L 11例，术后4~6个月，患者血清钙均>2.0 mmol/L。术后随访16~18个月，患者血清钙>2.0 mmol/L，无临床低钙症状。结论：在分化型甲状腺癌患者手术中，运用精细化被膜解剖法，有助于精准识别甲状旁腺并最大可能的原位保留甲状旁腺及其功能。
Application value of meticulous capsular dissection in thyroidectomy for differentiated thyroid carcinoma
Objective: To investigate the application value of meticulous capsular dissection in thyroidectomy for differentiated thyroid carcinoma (DTC). Methods: The data of 75 patients with DTC undergoing total thyroidectomy with central neck dissection from March 2011 to March 2015 were reviewed. Meticulous capsular dissection was applied in all patients for identification and preservation in situ of the parathyroid glands, and timely intraoperative parathyroid autotransplantation was performed in those with severe ischemic or inadvertently dissected parathyroid glands. Results: Of the 75 patients, all parathyroid glands were intraoperatively identified and preserved in situ in 46 cases, and 2 or 3 parathyroid glands were preserved in situ in the remaining cases. Twelve hours after operation, some patients had mild numbness in the lip and hands or feet, or slight convulsions, but no dyspnea, shock or other serious complications occurred in any of them. The serum calcium in 18 patients was lower than 2.0 mmol/L on one month after operation, the serum calcium in 11 patients was less than 2.0 mmol/L on 2 to 3 months after operation and the serum calcium in all patients was higher than 2.0 mmol/L on 4 to 6 months after operation. Postoperative follow-up was conducted for 16 to 18 months, and in all of them, the serum calcium was higher than 2.0 mmol/L, and no clinical symptoms of hypocalcemia were noted. Conclusion: Using meticulous capsular dissection in thyroidectomy for DTC patients can help accurately identify and as maximally as possible preserve the parathyroid glands in situ.