Медицинская литература. Новинки

 

 

 

 

 

 

Клинико-анатомические особенности кровоснабжения околощитовидных желез: серия наблюдений на аутопсийном материале

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Гипопаратиреоз является самым частым осложнением после оперативных вмешательств на щитовидной железе. Всеми исследователями подтверждается тот факт, что основной причиной гипопаратиреоза является нарушение кровоснабжения околощитовидных желез, а также их повреждение или даже случайное удаление во время операции. Анализируя литературу, собственный опыт, мы пришли к выводу о необходимости подробного изучения типов кровоснабжения околощитовидных желез с целью предупреждения данного осложнения. Нами выполнено 46 односторонних микродиссекций и рентгенангиографических исследований артериального русла на 23 органокомплексах шеи. Выявлены 42 верхние и 43 нижние околощитовидные железы. Установлено, что основным питающим сосудом околощитовидных желез является нижняя щитовидная артерия (I тип). Связь околощитовидных желез с нижней щитовидной артерией была выявлена в 71,8% случаев. Смешанный вариант кровоснабжения (одновременно от верхней и нижней щитовидных артерий) был выявлен в 14,1% случаев (II тип). Только 10,6% желез изолированно получали питание от верхней щитовидной артерии (III тип). В 8,7% случаев в препаратах отсутствовала нижняя щитовидная артерия. В 3,5% случаев достоверно связи нижних околощитовидных желез с щитовидными артериями не выявлено. Вероятно, их питание осуществлялось за счет мелких коллатералей из окружающих органов (VI тип).

Ключевые слова:
гипопаратиреоз, кровоснабжение околощитовидных желез, профилактика послеоперационного гипопаратиреоза, hypoparathyroidism, blood supply of parathyroid glands, prevention of postoperative hypoparathyroidism

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Clinical and anatomical features of blood supply of parathyroid glands: autopsy case series

Hypoparathyroidism is the most common complication after surgery on the thyroid gland. All authors confirm the fact that the main cause of hypoparathyroidism is a violation of the blood supply of parathyroid glands, as well as their damage or even accidental removal during surgery. Having analyzed the real cases, and based on our own experience, we came to the conclusion that in order to prevent complications, we will need to study the types of blood supply of the parathyroid glands in details. To this end, we have performed 46 unilateral microdissections and X-ray angiography studies of the arterial supply at 23 organocomplexes of the neck. 42 upper and 43 lower parathyroid glands were detected. It has been established that the main feeding vessel of parathyroid glands is the inferior thyroid artery (type I). The association of glands with the inferior thyroid artery was revealed in 71.8% of cases. A mixed variant of blood supply (simultaneously from the superior and inferior thyroid arteries) was revealed in 14.1% cases (type II). Only 10.6% of the gland were fed isolated from the superior thyroid artery (type III). In addition, in 8.7% cases in the preparations there was no inferior thyroid artery. In 3.5% cases, the connections of the lower parathyroid glands with the thyroid arteries were not reliably detected. Most probably, their feeding was provided at the expense of small collaterals from surrounding organs (type VI).

Keywords:
гипопаратиреоз, кровоснабжение околощитовидных желез, профилактика послеоперационного гипопаратиреоза, hypoparathyroidism, blood supply of parathyroid glands, prevention of postoperative hypoparathyroidism