策略性甲状旁腺自体移植在甲状腺乳头状癌再次中央区淋巴结清扫中的应用

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目的探讨策略性甲状旁腺自体移植是否能有效减少甲状腺乳头状癌(PTC)再次中央区淋巴结清扫术后甲状旁腺功能低下的发生率。方法回顾性分析2009年1月至2015年10月期间在四川大学华西医院甲状腺外科因PTC复发(淋巴结转移)再次行单侧或双侧中央区淋巴结清扫(包括颈侧区清扫)患者的临床资料,根据初次手术是否行策略性甲状旁腺自体移植分为移植组和未移植组。统计及比较2组患者一般情况、术前血Ca2+及甲状旁腺激素水平、首次手术方式、再次手术前是否存在声带麻痹、再次手术方式和术后并发症。结果 74例PTC再次手术患者纳入研究,其中移植组35例,未移植组39例。术后1 d血Ca2+及甲状旁腺激素水平移植组明显高于未移植组(P<0.05);移植组2例患者新出现喉返神经损伤,未移植组5例新出现喉返神经损伤(5.7%比12.8%,P>0.05);移植组和未移植组分别有4例和12例出现暂时性甲状旁腺功能低下,1例和4例出现永久性甲状旁腺功能低下,2组甲状旁腺功能低下发生率差异有统计学意义(14.3%比41.0%,P<0.05)。术后病理学检查结果提示2组中央区淋巴结清扫数目分别为(2.1±1.3)枚和(1.4±0.7枚),其差异有统计学意义(P<0.05)。结论策略性甲状旁腺自体移植可有效减少PTC再次中央区淋巴结清扫术后甲状旁腺功能低下的发生,从而大大提高手术安全性及彻底性。 Objective To investigate if strategic parathyroid autotransplantation can effectively reduce the incidence of hypoparathyroidism after secondary central lymph node dissection in papillary thyroid carcinoma (PTC). Methods The clinical data of patients with PTC recurrence (lymph node metastasis) at the thyroid surgery department of West China Hospital of Sichuan University from January 2009 to October 2015 were retrospectively reviewed in one or both sides of the central lymph node dissection , According to the first surgery whether the line of strategic parathyroid autograft divided into transplantation group and non-transplantation group. Statistics and comparison of two groups of patients in general, preoperative blood levels of Ca2 + and parathyroid hormone, the first surgical approach, whether before surgery before vocal cord paralysis, re-operation and postoperative complications. Results A total of 74 PTC patients undergoing reoperation were included in the study, of which 35 were transplanted and 39 were not transplanted. In the transplantation group, the levels of Ca2 + and parathyroid hormone in the transplantation group were significantly higher than those in the non-transplantation group (P <0.05); the recurrent laryngeal nerve injury occurred in 2 patients in the transplantation group, and 5 cases of recurrent laryngeal nerve injury 5.7% vs 12.8%, P> 0.05). Transplanted group and non-transplanted group had transient hypoparathyroidism in 4 cases and 12 cases, and permanent hypoparathyroidism in 1 case and 4 cases The incidence of hypoparathyroidism was significantly different (14.3% vs. 41.0%, P <0.05). Postoperative pathological examination showed that the number of lymphadenectasis in the central group was (2.1 ± 1.3) and (1.4 ± 0.7), respectively, with significant difference (P <0.05). Conclusion Strategic parathyroid autografting can effectively reduce the incidence of parathyroid after PTC resection in the central area, which can greatly improve the safety and thoroughness of the operation.
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