Wu Ying-Jun, Wang Jian-Biao, Li Fei-Bo, Jin Lei, Zhou Liang, Xie Lei
Department of Operation Room Nursing, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
Department of Head and Neck Surgery, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
Int J Endocrinol. 2022 Jun 25;2022:8747680. doi: 10.1155/2022/8747680. eCollection 2022.
Permanent hypoparathyroidism is a serious complication following total thyroidectomy plus central neck dissection (CND). How to evaluate the vascularization of the parathyroid gland in real time is a major concern of thyroid surgeons. This study aimed to evaluate the fine-needle pricking (FNP) test in predicting parathyroid gland function.
The FNP test was performed in patients undergoing total thyroidectomy plus CND between January 1, 2014, and December 31, 2019, to visualize the vascularization of the parathyroid glands. Patients were classified according to the number of parathyroid glands preserved with excellent vascularity (PGPIEV) demonstrated by FNP: group 0 (without PGPIEV), group 1 (with one PGPIEV), group 2 (with two PGPIEV), group 3 (with three PGPIEV), and group 4 (with four PGPIEV).
A total of 608 patients with four parathyroid glands underwent FNP testing during thyroidectomy. At least one PGPIEV was demonstrated by FNP testing in 581 patients who had intact parathyroid hormone (iPTH) levels in the normal range after the operation. The prevalence of hypocalcemia decreased from 77.8% in group 0 to 9.8% in group 4 ( < 0.001), and the incidence of hypoparathyroidism decreased from 44.4% in group 0 to 0% in groups 1-4 ( < 0.001). iPTH concentrations on postoperative day 1 were positively correlated with PGPIEV groups (increased from 14.58 ng/l in group 0 to 45.22 ng/l in group 4, < 0.001).
The FNP test is a safe and reliable method to predict parathyroid function. One PGPIEV demonstrated by the FNP test rules out the possibility of patients developing hypoparathyroidism.
永久性甲状旁腺功能减退是全甲状腺切除术加中央区颈淋巴结清扫术（CND）后的一种严重并发症。如何实时评估甲状旁腺的血管化是甲状腺外科医生主要关注的问题。本研究旨在评估细针穿刺（FNP）试验在预测甲状旁腺功能方面的作用。
在2014年1月1日至2019年12月31日期间，对接受全甲状腺切除术加CND的患者进行FNP试验，以观察甲状旁腺的血管化情况。根据FNP显示的具有良好血管化的甲状旁腺数量（PGPIEV）对患者进行分类：0组（无PGPIEV）、1组（有一个PGPIEV）、2组（有两个PGPIEV）、3组（有三个PGPIEV）和4组（有四个PGPIEV）。
共有608例有四个甲状旁腺的患者在甲状腺切除术中接受了FNP检测。581例术后甲状旁腺激素（iPTH）水平在正常范围内的患者通过FNP检测显示至少有一个PGPIEV。低钙血症的发生率从0组的77.8%降至4组的9.8%（<0.001），甲状旁腺功能减退的发生率从0组的44.4%降至1-4组的0%（<0.001）。术后第1天的iPTH浓度与PGPIEV组呈正相关（从0组的14.58 ng/l增加到4组的45.22 ng/l，<0.001）。
FNP试验是预测甲状旁腺功能的一种安全可靠的方法。FNP试验显示一个PGPIEV可排除患者发生甲状旁腺功能减退的可能性。
