Zheng Jianwei, Song Huimin, Cai Shuyan, Wang Yunlei, Han Xiaofeng, Wu Haoliang, Gao Zhigang, Qiu Fanrong
Department of General Surgery, Beijing Chaoyang Hospital Affiliated Capital Medical University, Beijing, China.
Medicine (Baltimore). 2017 Sep;96(39):e8175. doi: 10.1097/MD.0000000000008175.
We assessed the clinical significance and risk factors of incidental parathyroidectomy during total thyroidectomy with or without central neck dissection or subtotal thyroidectomy.Retrospective analysis of clinical and pathological features of 548 consecutive thyroidectomy cases was compared by grouping into inadvertent resection (IR, n = 86) with IR of parathyroid glands, non-IR (n = 462) without, and then into postoperative hypoparathyroidism (PH, n = 140) with PH and non-PH (n = 408) without.Two hundred ninety-eight patients had total thyroidectomy and 250 had subtotal thyroidectomy. IR had higher malignant disease (P < .001), total thyroidectomy (P = .016), T3 and T4 classification (P = .005), central neck dissection (P < .001), recurrent laryngeal nerve palsy (P = .003), postoperative transient hypoparathyroidism (P < .001), duration of disease prior to thyroidectomy (P < .001), and weight of excised thyroid tissue (P < .001) than non-IR.Preoperative diagnosis of malignant disease, duration of disease prior to thyroidectomy, and central neck dissection were independent risk factors for incidental parathyroidectomy. Preoperative diagnosis of malignant disease, central neck dissection, duration of disease prior to thyroidectomy, weight of excised thyroid tissue, and incidental parathyroidectomy were correlated with PH.
我们评估了在全甲状腺切除术(伴或不伴中央区颈清扫术)或次全甲状腺切除术中意外甲状旁腺切除术的临床意义及危险因素。通过将548例连续甲状腺切除术病例按甲状旁腺意外切除(IR,n = 86)与未发生IR(非IR,n = 462)分组,然后再按术后甲状旁腺功能减退(PH,n = 140)与未发生PH(非PH,n = 408)分组,对临床和病理特征进行回顾性分析。298例患者接受了全甲状腺切除术,250例接受了次全甲状腺切除术。与非IR相比,IR组的恶性疾病发生率更高(P <.001)、全甲状腺切除术比例更高(P =.016)、T3和T4分类比例更高(P =.005)、中央区颈清扫术比例更高(P <.001)、喉返神经麻痹发生率更高(P =.003)、术后短暂性甲状旁腺功能减退发生率更高(P <.001)、甲状腺切除术前疾病持续时间更长(P <.001)以及切除的甲状腺组织重量更大(P <.001)。术前诊断为恶性疾病、甲状腺切除术前疾病持续时间以及中央区颈清扫术是意外甲状旁腺切除术的独立危险因素。术前诊断为恶性疾病、中央区颈清扫术、甲状腺切除术前疾病持续时间、切除的甲状腺组织重量以及意外甲状旁腺切除术与PH相关。