甲状腺全切除术中甲状旁腺数量与功能性甲状旁腺保留的关系。
Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation.
机构信息
Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, T12, Ireland.
Department of Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland.
出版信息
Langenbecks Arch Surg. 2022 Feb;407(1):297-303. doi: 10.1007/s00423-021-02287-6. Epub 2021 Aug 18.
PURPOSE
Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily translates into optimized functional parathyroid preservation. We wished to investigate the association between number of parathyroids identified intraoperatively during TT, and incidence of incidental parathyroidectomy, and postoperative hypoparathyroidism.
METHODS
Retrospective review of prospectively maintained database of 511 consecutive patients undergoing TT at an academic teaching hospital. The association between number of parathyroid glands identified intraoperatively and incidence of biochemical hypocalcaemia (defined as any calcium < 2 mmol/L n first 48 h after surgery), symptomatic hypocalcaemia; permanent hypoparathyroidism (defined as any hypocalcaemia or need for calcium or vitamin D > 6 months after surgery), and incidental parathyroidectomy, was investigated. The association between number of parathyroid glands visualized and postoperative parathyroid hormone (PTH) levels was investigated in a subset of 454 patients.
RESULTS
Patients in whom a greater number of parathyroids had been identified had a significantly higher incidence of biochemical and symptomatic hypocalcaemia, and significantly lower postoperative PTH levels, than patients with fewer glands identified. There were no significant differences in incidence of permanent hypoparathyroidism or incidental parathyroidectomy. On multivariate analysis, malignancy, Graves disease, and identification of 3-4 parathyroids were independent predictors of biochemical hypocalcaemia. For symptomatic hypocalcaemia, identification of 2-4 parathyroids, and identification of 3-4 parathyroids, were significant.
CONCLUSIONS
Systematic identification of as many parathyroid glands as possible during TT is not necessary for functional parathyroid preservation.
目的
在甲状腺全切除术（TT）中已推荐系统性识别所有 4 个甲状旁腺；然而，这种策略是否必然转化为优化的功能性甲状旁腺保留仍不清楚。我们希望研究 TT 术中识别的甲状旁腺数量与偶然甲状旁腺切除术和术后甲状旁腺功能减退症的发生率之间的关系。
方法
回顾性分析在学术教学医院接受 TT 的 511 例连续患者的前瞻性维护数据库。研究了术中识别的甲状旁腺数量与生化低钙血症（定义为手术后前 48 小时任何钙 < 2mmol/L n）、症状性低钙血症；永久性甲状旁腺功能减退症（定义为任何低钙血症或手术后 6 个月以上需要钙或维生素 D > 6 个月）和偶然甲状旁腺切除术的发生率之间的关系。在 454 例患者的亚组中研究了甲状旁腺数量与术后甲状旁腺激素（PTH）水平之间的关系。
结果
与识别的腺体较少的患者相比，识别的甲状旁腺数量较多的患者生化和症状性低钙血症的发生率显著更高，术后 PTH 水平显著更低。永久性甲状旁腺功能减退症或偶然甲状旁腺切除术的发生率无显著差异。多变量分析显示，恶性肿瘤、Graves 病和识别 3-4 个甲状旁腺是生化低钙血症的独立预测因素。对于症状性低钙血症，识别 2-4 个甲状旁腺和识别 3-4 个甲状旁腺是显著的。
结论
在 TT 中尽可能多地识别甲状旁腺对于功能性甲状旁腺保留不是必需的。
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