甲状旁腺自体移植术在腔镜甲状腺癌根治术中的临床应用价值

The value of parathyroid autotransplantation in endoscopic radical operation for thyroid carcinoma

目的探讨腔镜甲状腺癌根治术中甲状旁腺自体移植对中央区淋巴结清扫的彻底性和术后甲状旁腺功能恢复的影响。方法回顾性分析2019年1月至2022年1月甘肃省人民医院普外科收治的152例行腔镜甲状腺癌根治术患者的临床资料,其中试验组80例行腔镜甲状腺癌根治术联合下位甲状旁腺移植术,原位保留3枚甲状旁腺;对照组72例行腔镜甲状腺癌根治术,4枚甲状旁腺均原位保留。统计患者术后甲状旁腺功能减退发生率、不同时间点血清甲状旁腺激素及钙离子水平、淋巴结清扫数目。结果试验组暂时性甲状旁腺功能减退率高于对照组,永久性甲状旁腺功能减退发生率低于对照组,差异有统计学意义(χ^(2)=6.243,P=0.029);术后1周、1、3、6、12个月,试验组的血清甲状旁腺激素高于对照组,差异有统计学意义(F=25.193,P<0.05);术后1、3、6、12个月,试验组血钙离子水平高于对照组,差异有统计学意义(F=3.268,P=0.005);试验组平均每例中央区淋巴结清扫数和阳性淋巴结数均高于对照组,差异均有统计学意义(t=2.000,P=0.047;t=2.014,P=0.046)。结论在腔镜甲状腺癌根治术中,行甲状旁腺自体移植术可有效预防术后永久性甲状旁腺功能减退,同时实现更为彻底的中央区淋巴结清扫。

ObjectiveTo evaluate the effects of parathyroid autotransplantation on total central lymph node dissection and postoperative parathyroid functional recovery in endoscopic radical operation for thyroid carcinoma.MethodThe data of 152 patients undergoing endoscopic radical operation for thyroid carcinoma are retrospectively analyzed.The incidence of postoperative hypoparathyroidism,serum PTH and Ca 2+concentrations at different time points,and the number of lymph nodes cleared were counted.ResultsThe rate of temporary hypoparathyroidism in the experimental group was higher than that in the control group,and the incidence of permanent hypoparathyroidism was lower than that in the control group,with statistically significant differences(χ^(2)=6.243,P=0.029).Patient's PTH in the experimental group is significantly higher than that in the control group at 1 week,1,3,6 and 12 months after operation,and the difference is statistically significant(F=25.193,P<0.05);Ca^(2+)concentration in experimental group is higher than that in control group at 1,3,6 and 12 months after operation,and the difference is statistically significant(F=3.268,P=0.005);The average number of central zone lymph node dissection and positive lymph nodes per case in the experimental group was higher than that in the control group,and the difference was statistically significant(t=2.000,P=0.047;t=2.014,P=0.046).ConclusionIn radical lumpectomy for thyroid cancer,parathyroid autotransplantation can effectively prevent permanent postoperative hypoparathyroidism while achieving a more complete lymph node dissection in the central region.