Wang Yonghui, Li Quancai, Fan Mingxiu, Ming Kunxiu
Department of Thyroid and Breast Surgery, Weifang People's Hospital, Weifang, Shandong, China.
Department of Neurosurgery, Weifang People's Hospital, Weifang, Shandong, China.
Front Endocrinol (Lausanne). 2024 Nov 26;15:1361736. doi: 10.3389/fendo.2024.1361736. eCollection 2024.
Benign multinodular goiter (BMNG) can grow very large and cause compression symptoms, making the operation procedure difficult. However, the recurrence rate of BMNG ranges from 3% to 43%. Reoperative thyroid surgery for BMNG is uncommon and can result in a high rate of complications, including hypoparathyroidism and recurrent laryngeal nerve palsy. Carbon nanoparticles (CNs) have been widely used as a protective agent for the parathyroid gland and as a tracer agent in central lymph node dissection. However, the protection effect of CNs in redoing BMNG has not been well illustrated. This study investigates whether CNs could protect parathyroid glands (PGs) during reoperation for patients with BMNG.
BMNG patients who previously underwent thyroidectomy and received reoperation between January 2019 and January 2022 were retrospectively recruited. The Dunhill approach was employed for all patients. The patients were divided into two groups: the CNs group, who received injection CNs injection 1 hour before the operation (n = 24), and the control group, who underwent thyroid surgery without CNs injection (control group, n = 25). The numbers of PGs preserved , autotransplantation, the accidental removal of the PGs, and the parathyroid hormone level were recorded and analyzed.
The results revealed that more PGs were preserved in the CNs group compared to the control group (3.25±0.15 2.60±0.16, P=.007). Moreover, fewer PGs were subjected to autotransplantation and were accidentally discovered in the specimen in the CNs group compared to the control group. Patients who had CNs injection exhibited a lower rate of transient (5/24 13/25, P=.024) and permanent hypoparathyroidism (2/24 9/25, P=.020) compared to the control group.
良性多结节性甲状腺肿（BMNG）可能长得非常大并引起压迫症状，使手术操作变得困难。然而，BMNG的复发率在3%至43%之间。BMNG的再次甲状腺手术并不常见，且可能导致包括甲状旁腺功能减退和喉返神经麻痹在内的高并发症发生率。碳纳米颗粒（CNs）已被广泛用作甲状旁腺的保护剂以及中央淋巴结清扫术中的示踪剂。然而，CNs在再次进行BMNG手术中的保护作用尚未得到充分阐明。本研究调查CNs在BMNG患者再次手术期间是否能保护甲状旁腺（PGs）。
回顾性招募2019年1月至2022年1月期间曾接受甲状腺切除术并接受再次手术的BMNG患者。所有患者均采用邓希尔手术方式。患者分为两组：CNs组，在手术前1小时接受CNs注射（n = 24）；对照组，未接受CNs注射而进行甲状腺手术（对照组，n = 25）。记录并分析保留的PGs数量、自体移植情况、PGs的意外切除情况以及甲状旁腺激素水平。
结果显示，与对照组相比，CNs组保留的PGs更多（3.25±0.15对2.60±0.16，P = 0.007）。此外，与对照组相比，CNs组中接受自体移植和在标本中意外发现的PGs更少。与对照组相比，接受CNs注射的患者出现短暂性（5/24对13/25，P = 0.02）和永久性甲状旁腺功能减退（2/24对9/25，P = 0.02）的发生率更低。
