Hong Yiyan, Zhan Hongliang, Zhang Longying, Huang Kunzhai, Zheng Miaomiao, Zhang Fuxing
The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
Department of General Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen, China.
Gland Surg. 2024 Oct 31;13(10):1729-1739. doi: 10.21037/gs-24-234. Epub 2024 Oct 26.
Recently, endoscope has been widely used in thyroid surgery and gasless insufflation transaxillary endoscopic thyroidectomy (GTET) has been the mainstay of thyroid surgery. Parathyroid gland (PG) damage is a common complication of thyroid surgery. Therefore, the aim of this study was to investigate the effect of GTET on hypoparathyroidism (HPT) in patients with thyroid cancer.
According to the surgical approach, the patients were divided into a GTET group and a conventional open thyroidectomy (COT) group. Univariate analysis and logistic regression were used to identify factors associated with PG injury. The odds ratio (OR) and 95% confidence interval (CI) for each independent variable were calculated.
A retrospective analysis was conducted on 405 patients diagnosed with papillary thyroid cancer (PTC). A total of 51 patients experienced PG injury, including 7 cases (5%) of GTET group and 44 cases (16.5%) of COT group (P<0.001). Among them, the incidence of GTET group injury with one PG was 50.4%, two were 2.9%, and COT group were 59.8% and 7.9%, respectively (P=0.006). Univariate and multivariate analysis revealed that GTET was a protective factor for PG injury (OR, 0.251; 95% CI, 0.110-0.576; P=0.001), while Hashimoto's thyroiditis (HT) was identified as a risk factor for PG injury (OR, 2.722; 95% CI, 1.114-6.654; P=0.02).
GTET reduces the incidence of PG injury and nerve injury, when PTC is combined with HT, it increases the risk of PG injury.
近年来，内镜已广泛应用于甲状腺手术，而无充气腋窝入路内镜甲状腺甲状腺切除术入路内镜甲状腺切除术（GTET）已成为甲状腺手术的主要术式。甲状旁腺（PG）损伤是甲状腺手术常见的并发症。因此，本研究旨在探讨GTET对甲状腺癌患者甲状旁腺功能减退症（HPT）的影响。
根据手术方式，将患者分为GTET组和传统开放性甲状腺切除术（COT）组。采用单因素分析和逻辑回归分析确定与PG损伤相关的因素。计算每个自变量的比值比（OR）和95%置信区间（CI）。
对405例诊断为甲状腺乳头状癌（PTC）的患者进行回顾性分析。共有51例患者发生PG损伤，其中GTET组7例（5%），COT组44例（16.5%）（P<0.001）。其中，GTET组单个PG损伤发生率为50.4%，两个PG损伤发生率为2.9%，COT组分别为59.8%和7.9%（P=0.006）。单因素和多因素分析显示，GTET是PG损伤的保护因素（OR，0.251；95%CI，0.110-0.576；P=0.001），而桥本甲状腺炎（HT）被确定为PG损伤的危险因素（OR，2.722；95%CI，1.114-6.654；P=0.02）。
GTET可降低PG损伤和神经损伤的发生率，当PTC合并HT时，会增加PG损伤的风险。
