両側頸部郭清術を併施した喉頭・下咽頭癌手術における副甲状腺温存術式の成功率 FUNCTIONAL MANAGEMENT OF THE PARATHYROID GLANDS IN SURGERY FOR ADVANCED MALIGNANCY OF THE LARYNX AND HYPOPHARYNX

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喉頭・下咽頭手術における副甲状腺温存術式の成功率を向上させることを目的に,自験例を検討した。対象は原発巣手術と両側頸部郭清術を行い,健側甲状腺・副甲状腺を温存した喉頭および下咽頭扁平上皮癌初回治療例59例とした。副甲状腺機能は術後3ヶ月に評価し,カルシウム補正を全く必要としない症例を成功例とした。<BR>疾患別,原発巣手術術式別の成功率に差異はなかった。T3以下とT4の間,健側頸部転移の有無で成功率に有意差はなかった。術中所見で上甲状腺静脈の温存が不充分と思われた症例では44.4%,温存甲状腺にうっ血を認めた症例では20.0%と成功率が低かった。これらの結果から,温存甲状腺にうっ血を生じない,確実な上甲状腺静脈の温存が副甲状腺機能温存に重要であると考えた。

To better understand ways to improve the preservation of function of the parathyroid glands in surgery for advanced malignancy of the larynx and hypopharynx, we did a retrospective analysis of 59 patients. These patients underwent total laryngectomy or total pharyngo-laryngectomy and bilateral neck dissection with preservation of the contnalateral thyroid gland and parathyroid glands. Results of preserving the parathyroid function were evaluated at 3 months after surgery based on the necessity of calcium replacement.<BR>The rates of successful preservation of the function of the parathyroid glands post-operatively were not significantly different between those who underwent surgery for laryngeal cancer and hypopharyngeal cancer. There were also no significant differences based on the surgery of the primary sites. T-stage and N-stage were not useful indicators. Most importantly for discriminating between success and failure, were the findings during surgery. Our analysis demonstrated that the function of the parathyroid glands was preserved in only 44.4% of the patients with insufficient preservation of the superior thyroid vein and 20.0% of the patients with congestion of the preserved thyroid glands.<BR>These results indicate that sufficient preservation of the superior thyroid vein and avoidance of congestion of the preserved thyroid gland were crucial for the post-operative functional management of the parathyroid glands in surgery for advanced malignancy of the larynx and hypopharynx.

収録刊行物

  • 頭頸部癌/ 日本頭頸部癌学会  

    頭頸部癌/ 日本頭頸部癌学会 32(4), 515-518, 2006-12-25 

    Japan Society for Head and Neck Cancer

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各種コード

  • NII論文ID(NAID)
    10018452889
  • NII書誌ID(NCID)
    AA11985555
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    13495747
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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