Perioperative functional protection of the parathyroid glands / 中华内分泌外科杂志

ABSTRACT

Perioperative protection of parathyroid function is the focus and difficulty of thyroid surgery and also a problem that surgeons must pay attention to. It can be divided into three stages: preoperative management, intraoperative management, and postoperative management. Preoperative management mainly evaluates thyroid and parathyroid function and timely and effective treatment plan adjustment when functional abnormalities are found. Intraoperative management includes identifying and protecting the parathyroid gland, assessing and protecting parathyroid blood flow, etc. Postoperative management includes assessment of postoperative parathyroid function, effective treatment, and follow-up. Among them, intraoperative management is the key. Familiarity with the anatomical structure is the basis of parathyroid function protection, and visual recognition is an essential skill. Secondly, reasonable selection of surgical methods and application of fine membrane dissection technology can avoid the collateral damage of energy instruments to the parathyroid gland and nourishing blood vessels, and finally, timely use of autologous transplantation technology. Using assistive techniques such as imaging can help accurately locate the parathyroid gland and assess its blood flow before surgery. Preoperative localization is even more critical for hyperparathyroidism due to the non-uniqueness and uncertainty of the location of the diseased glands. The objective of treatment is to remove the diseased parathyroid glands and protect normal parathyroid tissue. To standardize the functional protection of parathyroid gland during the perioperative period, domestic guidelines and expert consensus have proposed the "1+X" basic principle and the "1+X+1" general strategy of parathyroid gland protection, guiding to help reduce the incidence of parathyroid injury during thyroid surgery.