الفهرس 
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Abstract
Thyroid carcinoma is a common malignant disease of the thyroid. The incidence of thyroid carcinoma has steadily increased worldwide over the past few decades. Papillary thyroid carcinoma (PTC) is the most common pathologic type of thyroid carcinoma and accounts for about 80% of all thyroid carcinoma. Although PTC commonly exhibits indolent oncological behavior, it has the preference of regional lymph node metastasis. Lymph nodes of the central neck compartment, including the paratracheal, pre-tracheal, and pre-laryngeal lymph nodes, are the most common locations involved. It had been proven that 40-60% of patients with PTC showed lymph node metastasis at the time of the primary operation
Due to PTC’s commonly seen regional lymph node metastasis, central neck dissection (CND) has been advocated by American Thyroid Association (ATA) in patients with advanced PTC (T3, T4 stage) and clinical lymph node metastasis. However, the routine performance of prophylactic CND is controversial due to the hypoparathyroidism that it may cause. A multiple-centered study demonstrated that 16.2% of patients that underwent total thyroidectomy and concomitant bilateral central neck dissection developed permanent hypoparathyroidism
Because of the application of “meticulous capsular dissection,” how to preserve the parathyroid gland in thyroidectomy has become a minor problem. Because inferior parathyroid glands (IPTGs) enjoy a more variable position in the adult neck and locate in the area of central neck lymph node dissection, how to preserve IPTG during CND is a major problem. To solve this main problem, “a layer of TBP” was firstly put forward by Lei Xie in 2014 This new concept has two meanings: (1) the thymus, IPTG and blood vessels connecting them are located in one layer; (2) the layer covers the common carotid artery (innominate artery), the trachea, and the area of paratracheal lymph nodes between them.
The aim of this study is to approve that in situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma using the TBP layer’ (layer of thymus-blood vesselinferior parathyroid gland) approach can greatly improve the success rate of Inferior Para-Thyroid Gland preservation in situ, thereby efficiently decreasing the incidence of temporary postoperative hypo-parathyroidism, while ensuring the completeness of lymph node dissection.
This study was conducted on thirty patients suffering from papillary thyroid carcinoma at Menoufia University Hospital. During the period from 2019 till 2020. For every patient the following was done: Complete history taken, Sorrow clinical examination, pre-operative investigations including Serum Free T3, Free T4, TSH, Serum calcium, Liver function tests, Kidney function tests, Complete blood count, Random blood sugar, Prothrombin time and concentration, meticulous, bloodless surgical field, capsular dissection and ligation of all blood vessels as close as possible to the thyroid capsule, preservation of middle thyroid, Identification of Inferior Para-Thyroid Gland, ligation of posterior branch of superior thyroid artery and the accompanying vein distal to branching of the superior parathyroid vascular pedicle, ligation of inferior thyroid artery tertiary branches, postoperative investigations.