霍普金斯手术记录：甲状旁腺次全切除

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Title of Operation:

Subtotal parathyroidectomy.  Recurrent laryngeal nerve monitoring.

Indications for Surgery:

Preoperative Diagnosis:

Secondary/tertiary hyperparathyroidism.

Postoperative Diagnosis:

Secondary/tertiary hyperparathyroidism.

Anesthesia:

Specimen (Bacteriological, Pathological or other):

Prosthetic Device/Implant:

Surgeons Narrative:

Operative Findings:  Significantly enlarged parathyroid for gland hyperplasia.

Operative Procedure:  After general anesthesia with endotracheal intubation, the patient"s neck was prepped and draped in normal sterile fashion.  She was placed in a semi-Fowler position with the neck hyperextended.  SCDs were up and working prior to anesthesia.  A limited collar incision was made first on the right side through skin and platysma.  Superior and inferior flaps were created in the usual fashion to thyroid cartilage superiorly, sternal notch inferiorly.  Strap muscles were divided longitudinally in the midline retracted to the right.  Blunt and sharp dissection reveal a middle thyroid vein.  This was taken between clamps and tied with 2-0 and 3-0 silk suture.  There was a large inferior parathyroid gland within the thymus and a large superior gland within the tracheoesophageal groove.  Because of this the wound was extended to the left side and the left side explored.  Exploration revealed a large parathyroid gland within the thymus on the left as well as a slightly enlarged left upper gland in the tracheoesophageal groove.  This was left in situ and clipped anteriorly.  The left inferior parathyroid gland was carefully dissected and excised.  Frozen section revealed parathyroid tissue.  Pathology did not give us a wait and which we then passed for. Further dissection included the removing the right inferior parathyroid gland was significantly enlarged in the right superior parathyroid gland was in the tracheoesophageal groove.  Recurrent laryngeal nerve was noted and carefully preserved on both sides.  Its function was documented in recurrent laryngeal nerve monitor.  The baseline PTH was 240 after removal of the left lower was 164 at time zero but we did not get specimens back except the 10 minutes after removal of the right upper gland.  The PTH was 240, the other PTH values were not available to us during that during the operation.  However, it was felt the patient was cured.  The wound was irrigated copiously with normal saline.  Bleeding vessels were either retied or recauterized.  Strap muscles were closed with running locking 3-0 Vicryl suture.  Platysma was closed with interrupted 3-0 Vicryl suture.  Skin was closed with running subcuticular 4-0 Biosyn.  Benzoin, Steri-Strips, and a dry sterile dressing were applied.  The patient tolerated procedure very well and sent to recovery room in stable condition.  I was present for the entire case.

CLINICAL STAGE OF TUMOR:

CC List:

Referring Physician CC List: