单侧甲状旁腺次全切除术联合中央区淋巴结清扫术治疗甲状腺乳头状癌：一项回顾性队列研究。
Single inferior parathyroid autotransplantation during total thyroidectomy with bilateral central lymph node dissection for papillary thyroid carcinoma: a retrospective cohort study.
机构信息
Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
出版信息
World J Surg Oncol. 2023 Mar 23;21(1):102. doi: 10.1186/s12957-023-02886-1.
BACKGROUND
Management of the inferior parathyroid gland using total thyroidectomy (TT) with central lymph node dissection (CLND) is still controversial. Therefore, we evaluated the safety and effectiveness of single inferior parathyroid autotransplantation.
METHODS
The clinical data of patients with papillary thyroid carcinoma (PTC) who underwent TT with bilateral CLND from January 2018 to December 2020 were collected. Quality of life (QoL) was assessed using the Chinese version of the EORTC QLQ-C30 and THYCA-QOL. The patients were divided into an autotransplantation group and a preservation group according to whether a single inferior parathyroid gland was transplanted. The incidence of permanent hypoparathyroidism, the number of resected central lymph nodes (CLNs), the rate of recurrence reoperation, the rate of radioactive iodine (RAI) treatment, and the QoL score were compared between the two groups.
RESULTS
A total of 296 patients were included in the study; there were 99 patients in the autotransplantation group and 197 in the preservation group. The incidence of permanent hypoparathyroidism was 3.0% (3/99) and 4.6% (9/197) in the autotransplantation and preservation groups, respectively (P = 0.532). The median number of resected CLNs was 12 (8-17) and 10 (6-14) in the autotransplantation and preservation groups, respectively (P = 0.015). No reoperations were performed for patients with CLN recurrence, and the rates of lateral lymph node (LLN) recurrence reoperation were 2.0% (2/99) and 3.6% (7/197) in the autotransplantation and preservation groups, respectively (P = 0.473). The RAI treatment rates were 12.1% (12/99) and 22.3% (44/197) in the autotransplantation and preservation groups, respectively (P = 0.034). A total of 276 questionnaires were recovered, including 84 in the autotransplantation group and 192 in the preservation group. The QoL of the two groups of patients is similar (P > 0.05).
CONCLUSION
Single inferior parathyroid autotransplantation during thyroidectomy can be used to prevent permanent hypoparathyroidism and can enable more extensive CLND.
背景
在甲状腺全切除术（TT）中使用中央淋巴结清扫术（CLND）来管理副甲状腺仍存在争议。因此，我们评估了单次副甲状腺自体移植的安全性和有效性。
方法
收集了 2018 年 1 月至 2020 年 12 月期间接受 TT 双侧 CLND 的甲状腺乳头状癌（PTC）患者的临床数据。使用 EORTC QLQ-C30 和 THYCA-QOL 中文版评估生活质量（QoL）。根据是否移植单个副甲状腺，将患者分为自体移植组和保留组。比较两组患者永久性甲状旁腺功能减退症的发生率、切除的中央淋巴结（CLNs）数量、复发再手术率、放射性碘（RAI）治疗率和 QoL 评分。
结果
共纳入 296 例患者；自体移植组 99 例，保留组 197 例。自体移植组和保留组永久性甲状旁腺功能减退症的发生率分别为 3.0%（3/99）和 4.6%（9/197）（P=0.532）。自体移植组和保留组切除的 CLNs 中位数分别为 12（8-17）个和 10（6-14）个（P=0.015）。无 CLN 复发的患者再次手术，自体移植组和保留组侧颈淋巴结（LLN）复发再手术率分别为 2.0%（2/99）和 3.6%（7/197）（P=0.473）。RAI 治疗率分别为 12.1%（12/99）和 22.3%（44/197）（P=0.034）。共回收 276 份问卷，包括自体移植组 84 份，保留组 192 份。两组患者的 QoL 相似（P＞0.05）。
结论
甲状腺切除术时进行单次副甲状腺自体移植可预防永久性甲状旁腺功能减退症，并可使更广泛的 CLND 成为可能。
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