Xiang Dapeng, Xie Liangqi, Li Zhiyu, Wang Ping, Ye Mao, Zhu Mingzhu
Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China.
Department of Molecular and Cellular Biology, UC Berkeley, Berkeley, CA, USA.
Endocrine. 2016 Sep;53(3):747-53. doi: 10.1007/s12020-016-0884-y. Epub 2016 Feb 17.
Increasing number of patients with thyroid carcinoma, especially young female patients, prefer to choose endoscopic thyroidectomy with bilateral central neck dissection (ETBC) for perfect cosmetic effects. However, the incidence of hypoparathyroidism after ETBC has not been well studied. Ninety six patients with papillary thyroid carcinoma were enrolled. All patients, including 49 ETBC and 47 open surgery patients, underwent total thyroidectomy with bilateral central neck dissection (CND). Some patients also underwent lateral neck dissection simultaneously. The incidence of hypoparathyroidism and parathyroid hormone (PTH) level were examined. Patients in the open surgery group had more advanced lesions, with larger tumor (p = 0.000), older age (p = 0.000), and more serious local involvement. The dissection extent of the open group was significantly larger than that of the ETBC group (p = 0.006). In contrast, the ETBC group with less dissection extent showed a significantly higher incidence of transient hypoparathyroidism than the open group (59.2 vs. 29.6 %, p = 0.004). The average PTH decline of the ETBC group was significantly higher than that of the open group on postoperative day 1 (POD1) (32.1 vs. 21.6 pg/ml, p = 0.010). Furthermore, the ETBC group had a significantly higher portion of patients with a PTH <10 pg/ml on POD1 (p = 0.001). One patient in the ETBC group developed permanent hypoparathyroidism. Autotransplantation and inadvertent removal rates of parathyroid did not differ between the two groups. Although generally considered a safe method for patients with thyroid carcinoma, ETBC may increase the risk of transient hypoparathyroidism compared with conventional open surgery.
越来越多的甲状腺癌患者，尤其是年轻女性患者，为了获得完美的美容效果，倾向于选择内镜甲状腺切除术加双侧中央区颈淋巴结清扫术（ETBC）。然而，ETBC术后甲状旁腺功能减退的发生率尚未得到充分研究。纳入了96例乳头状甲状腺癌患者。所有患者，包括49例行ETBC的患者和47例行开放手术的患者，均接受了全甲状腺切除术加双侧中央区颈淋巴结清扫术（CND）。部分患者同时还接受了侧颈淋巴结清扫术。检测了甲状旁腺功能减退的发生率和甲状旁腺激素（PTH）水平。开放手术组患者的病变程度更严重，肿瘤更大（p = 0.000），年龄更大（p = 0.000），局部侵犯更严重。开放组的清扫范围明显大于ETBC组（p = 0.006）。相比之下，清扫范围较小的ETBC组暂时性甲状旁腺功能减退的发生率明显高于开放组（59.2% 对29.6%，p = 0.004）。术后第1天（POD1），ETBC组的平均PTH下降幅度明显高于开放组（32.1对21.6 pg/ml，p = 0.010）。此外，ETBC组在POD1时PTH<10 pg/ml的患者比例明显更高（p = 0.001）。ETBC组有1例患者发生永久性甲状旁腺功能减退。两组甲状旁腺的自体移植率和误切率无差异。尽管ETBC通常被认为是甲状腺癌患者的一种安全方法，但与传统开放手术相比，它可能会增加暂时性甲状旁腺功能减退的风险。
