改良Miccoli术式下甲状腺全切除病人甲状旁腺功能保护的研究

Study on the preservation of parathyroid glands after modified Miccoli′s endoscopic thyroidectomy

目的:探讨甲状腺全切除术后病人甲状旁腺功能减退的影响因素及改良Miccoli术式对于甲状旁腺功能保护的作用。方法:回顾性分析2012年8月至2013年7月在我科行甲状腺全切除的206例病人临床病理资料,根据手术范围分为甲状腺全切除组、全切除+单侧中央区清扫组、全切除+双侧中央区清扫组,对术后甲状旁腺功能减退的可能因素进行分析。结果:206例病人中33例出现甲状旁腺功能减退(16.0%),其中1例为永久性甲状旁腺功能减退(0.5%)。不同年龄、性别、原发灶手术范围的病人术后甲状旁腺功能减退的发生无统计学差异(P>0.05)。甲状腺恶性肿瘤(P=0.048)、原位保留甲状旁腺数量减少(P=0.003)、中央区淋巴结转移>7枚(P=0.036)的病人,易发生甲状旁腺功能减退。结论:术后甲状旁腺功能减退与原发灶性质、原位保留甲状旁腺数量、中央区淋巴结转移数量有关,改良Miccoli术式在一定程度有利于术中更好地发现和保护甲状旁腺。

Objective To investigate both the risk factors for hypoparathyroidism after total thyroidectomy and the effect of preservation of parathyroid glands by modified Miccoli＇s endoscopic thyroidectomy. Methods Two hundred and six patients with total thyroidectomy were analyzed from August 2012 to July 2013 retrospectively. The patients were divided into three groups （total thyroidecomy, total thyroidectomy with unilateral lymph node dissection, and total thyroideetomy with bilateral lymph node dissection）. The risk factors of postoperative hypoparathyroidism were analyzed. Results Thirty-three patients （16.0%） with hypoparathyroidism were found in 206 patients and 1 patients （0.5%） with permanent hypoparathyroidism. There was no significant difference of the morbidity between the different age, sex and surgical mode（P〉0.05）. The factor related with hypoparathyroidism were malignancy（P=0.048）, less preserved parathyroid in situ（P=0.003） and metastatic lymph nodes more than 7 in central compartment（P=0.036）. Conclusions Hypoparathyroidism after total thyroidecomy might be associated with malignancy of tumor, the number of preserved parathyroid in situ and the number of metastatic lymph nodes in central compartment. Modified Miccoli＇s endoscopic thyroidectomy is useful to distinguish and preserve parathyroids during surgery.