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目的比较全腔镜下胸乳入路和传统颈前开放入路行甲状腺全切除术对甲状腺乳头状癌术后甲状旁腺功能的影响。方法回顾性分析2014年6月至2015年12月期间解放军总医院第一附属医院普外科收治的124例甲状腺乳头状癌患者的临床资料,所有患者均行甲状腺全切除术+中央区(第Ⅵ区)淋巴结清扫术。其中48例采用全腔镜下胸乳入路(全腔镜下胸乳入路组),76例采用传统颈前开放入路(颈前开放入路组)。比较2组术前和术后1 d的血清全段甲状旁腺激素(i PTH)和血清钙水平。结果 124例患者术前的血清i PTH和血清钙水平均在正常范围内,且2组术前的血清i PTH和血清钙水平比较差异均无统计学意义(P>0.05)。术后1 d时全腔镜下胸乳入路组和颈前开放入路组的血清i PTH水平〔(20.8±5.7)pg/m L比(28.3±4.9)pg/m L〕和血清i PTH水平低下比例〔43.8%(21/48)比22.4%(17/76)〕比较差异均有统计学意义,全腔镜下胸乳入路组的血清i PTH水平较低,且血清i PTH水平低下比例较高(P<0.05);术后1 d时2组患者的血清钙水平均在正常范围内,且2组的血清钙水平比较差异无统计学意义〔(2.1±0.3)mmol/L比(2.0±0.5)mmol/L〕,P>0.05。术后全腔镜下胸乳入路组的口周及手足麻木症状发生率高于颈前开放入路组〔47.9%(23/48)比27.6%(21/76)〕,P<0.05。结论相比传统颈前开放入路,全腔镜下胸乳入路更容易导致手术后血清i PTH水平降低,其术后患者出现口周和手足麻木症状的比例高。
Objective To compare the effects of total thyroidectomy on the parathyroid function after thyroidectomy for thyroid papillary carcinoma under endoscopic transluminal thoracoscopic approach and traditional anterior approach. Methods The clinical data of 124 patients with thyroid papillary carcinoma admitted to the General Surgery Department of the First Affiliated Hospital of PLA General Hospital from June 2014 to December 2015 were retrospectively analyzed. All patients underwent total thyroidectomy + central region (Ⅵ District) lymph node dissection. Forty-eight patients underwent endoscopic thoracoscopic (endoscopic thoracoscopic approach) and 76 underwent open anterior (open anterior approach). The serum parathyroid hormone (i PTH) and serum calcium levels were compared between the two groups before and 1 day after operation. Results The preoperative serum i PTH and serum calcium levels of 124 patients were within the normal range. There was no significant difference in serum i PTH and serum calcium levels between the two groups before operation (P> 0.05). At 1 d after operation, the serum i PTH level 〔(20.8 ± 5.7) pg / m L (28.3 ± 4.9) pg / m L〕 and serum i The PTH level was lower (43.8% (21/48) vs 22.4% (17/76)). There was a significant difference in the level of serum PTH in patients undergoing endoscopic breast-chest approach and the serum i-PTH (P <0.05). The level of serum calcium in the two groups was within the normal range on the first day after operation, and there was no significant difference in serum calcium between the two groups (〔(2.1 ± 0.3) mmol / L ratio (2.0 ± 0.5) mmol / L〕, P> 0.05. The incidence of perioral and hand-foot numbness in the breast-chest approach was significantly higher than that in the open-neck approach [47.9% (23/48) vs 27.6% (21/76)], P <0.05. Conclusion Compared with the traditional approach of open anterior approach, endoscopic thoracoscopic approach is more likely to lead to a decrease in serum i-PTH level after surgery. The postoperation patients have a high proportion of perioral and hand-foot numbness symptoms.