全腔镜下乳晕入路甲状腺全切术治疗甲状腺乳头状癌对甲状旁腺功能的影响

Effect of Total Thyroidectomy by Total Endoscopic Areola Approach on Parathyroid Function in the Treatment of Thyroid Papillary Carcinoma

目的:探讨全腔镜下乳晕入路甲状腺全切术治疗甲状腺乳头状癌对甲状旁腺功能影响。方法:收集承德医学院附属医院2020年3月至2023年1月双侧甲状腺微小乳头状癌行甲状腺全切术130例患者的临床资料进行回顾性分析。其中经全乳晕入路行甲状腺全切除+中央区淋巴结清扫术30例,传统颈前入路行甲状腺全切除+中央区淋巴结清扫术100例。比较两组患者术前、术后1d、7d、1个月、3个月、6个月的血清甲状旁腺素和血钙水平。结果:两组患者术前、术后1d、7d、3个月、6个月的血清甲状旁腺素和血钙水平差异无统计学意义(P>0.05)。术后1个月,两组患者血清甲状旁腺素和血钙水平差异有统计学意义(P<0.05),其中全乳晕手术组下降幅度更大(P<0.05)。术后均给予口服或静脉补钙治疗。6个月后,全乳晕入路组血清甲状旁腺素<15pg/mL者4例,传统入路组11例。6个月后,血钙低于2.0mmoL/L者全乳晕入路组2例,传统颈前入路组4例。结论:对于甲状腺全切术,全腔镜下乳晕入路与传统颈前入路二者永久性甲状旁腺功能减退的发生率无统计学意义。对于有美容需求的患者,全腔镜下乳晕入路甲状腺全切术是安全有效的手术方式。

Objective:To investigate the impact of transareolar endoscopic thyroidectomy on parathyroid function in the treatment of papillary thyroid carcinoma.Methods:Clinical data of 130 patients with bilateral micro papillary thyroid carcinoma who underwent total thyroidectomy from March 2020 to January 2023 at the Affiliated Hospital of Chengde Medical College were collected and retrospectively analyzed.Among them,30 cases underwent total thyroidectomy with central lymph node dissection through the transareolar route,and 100 cases underwent total thyroidectomy with central lymph node dissection through the traditional neck approach.Serum parathyroid hormone and blood calcium levels were compared between the two groups before surgery and at 1 day,7 days,1 month,3 months,and 6 months after surgery.Results:There was no statistically significant difference in serum parathyroid hormone and blood calcium levels between the two groups before surgery,at 1 day,7 days,3 months,and 6 months after surgery(P>0.05).At 1 month after surgery,there was a statistically significant difference in serum parathyroid hormone and blood calcium levels between the two groups(P<0.05),with a greater decrease in the transareolar surgery group(P<0.05).Calcium supplementation was given orally or intravenously after surgery.After 6 months,4 cases in the transareolar approach group had serum parathyroid hormone levels<15 pg/mL,while 11 cases in the traditional approach group had levels<15 pg/mL.After 6 months,2 cases in the transareolar approach group had blood calcium levels<2.0 mmoL/L,while 4 cases in the traditional neck approach group had levels<2.0 mmoL/L.Conclusion:For total thyroidectomy,there was no statistically significant difference in the incidence of permanent parathyroid dysfunction between transareolar endoscopic thyroidectomy and traditional open neck approach.For patients with cosmetic needs,transareolar endoscopic thyroidectomy is a safe and effective surgical approach.