Du Wei, Fang Qigen, Zhang Xu, Cui Meng, Zhao Ming, Lou Weihua
Department of Head Neck, First Affiliated Hospital of Zhengzhou University Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
Medicine (Baltimore). 2017 Mar;96(11):e6411. doi: 10.1097/MD.0000000000006411.
In this study, we investigated incidental parathyroidectomy during total thyroidectomy surgery that required central lymph node dissection and the potential risk factors. Patients requiring total thyroidectomy and tracheoesophageal groove node dissection were enrolled in the study from January 2013 to June 2015 and we obtained all medical information, including pathology reports. Furthermore, we recorded the parathyroid hormone level in all patients prior to operation and then 3 further times: 1 day, 1 week, and 3 months after surgery. A total of 341 patients (66 male and 275 female) were enrolled in the study. Microscopic examination of postoperative specimens revealed that incidental parathyroidectomy existed in 35 (10.3%) cases: 32 (91.4%) patients had 1 parathyroid gland excised, 3 (8.6%) patients had 2 parathyroid glands excised, and no patients had 3 or more parathyroid glands resected. The mean size of the resected glands was 4.6 mm. Parathyroid tissue from 16 (42.1%) cases was located in the intrathyroidal position, 6 glands were located in central lymphatic adipose tissue, and 16 glands were located within or along with thymus tissue. Lateral neck dissection significantly increased the risk of incidental parathyroidectomy (P < 0.001). No other factors including age, sex, and postoperative symptomatic hypocalcemia were significantly associated with incidental parathyroidectomy (all P > 0.05), though incidental parathyroidectomy tended to cause transient hypoparathyroidism (P = 0.051). Therefore, the risk of incidental parathyroidectomy in total thyroidectomy is relatively low; the majority of the resected parathyroid tissue is situated outside the thyroid, therefore we suggest future operations focus on preserving the parathyroid gland when the node dissection is close to the thymus. Incidental parathyroidectomy appears to have an effect on the expression of parathyroid hormone and it is significantly associated with lateral cervical lymph node dissection.
在本研究中，我们调查了在需要进行中央淋巴结清扫的全甲状腺切除术中的意外甲状旁腺切除术及其潜在危险因素。2013年1月至2015年6月期间，将需要进行全甲状腺切除术和气管食管沟淋巴结清扫的患者纳入研究，并获取了所有医疗信息，包括病理报告。此外，我们记录了所有患者术前以及术后1天、1周和3个月时的甲状旁腺激素水平。共有341例患者（66例男性和275例女性）纳入本研究。术后标本的显微镜检查显示，35例（10.3%）存在意外甲状旁腺切除术：32例（91.4%）患者切除了1个甲状旁腺，3例（8.6%）患者切除了2个甲状旁腺，没有患者切除3个或更多甲状旁腺。切除腺体的平均大小为4.6毫米。16例（42.1%）病例的甲状旁腺组织位于甲状腺内，6个腺体位于中央淋巴脂肪组织中，16个腺体位于胸腺组织内或与胸腺组织一起。侧颈清扫术显著增加了意外甲状旁腺切除术的风险（P<0.001）。尽管意外甲状旁腺切除术倾向于导致短暂性甲状旁腺功能减退（P=0.051），但包括年龄、性别和术后症状性低钙血症在内的其他因素与意外甲状旁腺切除术均无显著相关性（所有P>0.05）。因此，全甲状腺切除术中意外甲状旁腺切除术的风险相对较低；大多数切除的甲状旁腺组织位于甲状腺外，因此我们建议未来手术在淋巴结清扫靠近胸腺时着重保护甲状旁腺。意外甲状旁腺切除术似乎对甲状旁腺激素的表达有影响，并且与侧颈淋巴结清扫显著相关。
