中华普通外科杂志2024,Vol.39Issue(8) :598-603.DOI:10.3760/cma.j.cn113855-20230825-00081

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

张琪 曹廷宝 张宇鹏 孙安 王瑞红 伊同英 屈坤鹏
中华普通外科杂志2024,Vol.39Issue(8) :598-603.DOI:10.3760/cma.j.cn113855-20230825-00081

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

张琪 1曹廷宝 1张宇鹏 1孙安 1王瑞红 1伊同英 2屈坤鹏1
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作者信息

  • 1. 甘肃省中心医院普外三科,兰州 730000
  • 2. 甘肃省中心医院麻醉手术室,兰州 730000
  • 折叠

摘要

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(x2=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.

Abstract

Objective To evaluate the effects of parathyroid autotransplantation on total central lymph node dissection and postoperative parathyroid functional recovery in endoscopic radical operation for thyroid carcinoma.Method The data of 152 patients undergoing endoscopic radical operation for thyroid carcinoma are retrospectively analyzed.The incidence of postoperative hypoparathyroidism,serum PTH and Ca2+concentrations at different time points,and the number of lymph nodes cleared were counted.Results The 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(x2=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);Ca2+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).Conclusion In 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.

关键词

甲状腺肿瘤/器官移植/甲状旁腺功能减退/淋巴结切除术

Key words

Thyroid neoplasms/Organ transplantation/Hypoparathyroidism/Lymph node excision

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基金项目

甘肃省自然科学基金(23JRRA1384)

出版年

2024
中华普通外科杂志
中华医学会

中华普通外科杂志

CSTPCD北大核心
影响因子:1.11
ISSN:1007-631X
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