甲状腺癌手术入路选择对甲状旁腺功能保护的影响

The effect of operative approach selection on the protection of parathyroid function in thyroid cancer

目的探讨腔镜甲状腺手术和开放甲状腺手术对甲状腺癌患者术后甲状旁腺功能的影响。方法回顾性分析2018年7月至2019年9月于郑州大学附属郑州中心医院行手术治疗的73例符合入组标准的甲状腺癌患者的病例资料,其中男17例,女56例,年龄19~55岁。按照手术入路不同分为常规开放甲状腺全切+双侧中央区淋巴清扫组(A组)31例、经口腔前庭入路甲状腺全切+双侧中央区淋巴清扫组(B组)19例以及经胸前入路甲状腺全切+双侧中央区淋巴清扫组(C组)23例,分析比较3组患者手术后甲状旁腺激素(parathyroid hormone,PTH)及血钙水平的变化。应用SPSS 21.0及GraphPad Prism v6.01软件进行统计学分析。结果3组患者术后第1天PTH和血钙水平均较术前明显降低,差异有统计学意义(P值均<0.05)。术后第1天C组PTH及血钙水平明显低于A组和B组,差异有统计学意义[PTH:A组(22.2±13.2)pg/ml比C组(12.3±9.0)pg/ml,t=3.04,P=0.004;B组(20.0±14.1)pg/ml比C组(12.3±9.0)pg/ml,t=2.09,P=0.043;血钙:A组(2.02±0.16)mmol/L比C组(1.89±0.11)mmol/L,t=3.24,P=0.002;B组(2.01±0.15)mmol/L比C组(1.89±0.11)mmol/L,t=2.72,P=0.010]。A组与B组术后PTH及血钙水平差异无统计学意义(t=0.54、0.29,P值均>0.05)。永久性甲状旁腺功能减退和持续性低钙血症在A组、B组、C组的发生率分别为3.2%(1/31)、5.3%(1/19)、21.7%(5/23),C组的发生率明显高于非C组4.0%(2/50),差异有统计学意义(χ2=5.251,P=0.022)。结论甲状腺癌术后患者的甲状旁腺功能和血钙水平均有不同程度的变化,经口腔前庭入路和常规开放甲状腺手术对甲状旁腺的保护可以得到相同的效果,并优于经胸前入路甲状腺手术。

Objective To investigate the effect of endoscopic thyroidectomy and open thyroidectomy on parathyroid function in patients with thyroid cancer.Methods The clinical data of 73 patients with thyroid cancer who met the inclusion criteria in Zhengzhou Central Hospital Affiliated to Zhengzhou University from July 2018 to September 2019 were retrospectively analyzed,including 17 males and 56 females,aged 19-55 years.The patients underwent routine thyroidectomy(group A,n=31),oral endoscopic thyroidectomy by vestibular approach(group B,n=19)or transthoracic thyroidectomy(group C,n=23),and all patients received central neck dissection.The levels of parathyroid hormone(PTH)and serum calcium after operation were compared among three groups.SPSS 21.0 software and GraphPad Prism v6.01 were used for statistical analysis.Results After operation,the mean levels of PTH and serum calcium in three groups were significantly decreased(all P<0.05).On the first day after operation,the mean level of PTH in group C was lower than that in group A[(12.3±9.0)vs.(22.2±13.2)pg/ml,t=3.04,P=0.004]or group B[(12.3±9.0)vs.(20.0±14.1)pg/ml,t=2.09,P=0.043],and also the level of serum calcium in group C was lower than that in group A[(1.89±0.11)vs.(2.02±0.16)mmol/L,t=3.24,P=0.002]or group B[(1.89±0.11)vs.(2.01±0.15)mmol/L,t=2.72,P=0.010],with no significant difference in the mean levels of PTH or serum calcium between group A and group B(t=0.54,0.29,respectively,both P>0.05).The incidences of permanent hypoparathyroidism/persistent hypocalcemia were 3.2%(1/31)in group A,5.3%(1/19)in group B and 21.7%(5/23)in group C,and the incidence of group C was significantly higher than that(4%,2/50)of both group A and group B(χ2=5.251,P=0.022).Conclusion The postoperative parathyroid function and serum calcium level have different degrees of change and they are significantly associated with thyroidectomy approaches,the protection of parathyroid by oral endoscopic thyroidectomy and routine thyroidectomy can achieve the same effect,and is better than that of transthoracic thyroidectomy.