Yuan Jianming, Gu Jianhua, Ding Min, Jin Xiaoli, Tan Dan, Li Tingting, Xu Wenjuan, Wang Shujing, Shen Yi, Shen Dongjie, Xu Dan, Zeng Yaoxing, Xiao Guohui, Xie Rongli, Fei Jian
Department of General Surgery, RuiJin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of General Surgery, Intergrated Traditional and Western Medicine Hospital of Huangpu District, Shanghai, China.
BMC Cancer. 2025 Aug 12;25(1):1309. doi: 10.1186/s12885-025-14690-z.
Iatrogenic injury of the parathyroid gland during thyroid surgery cannot be completely avoided. The lateral approach is the most commonly used surgical approach in traditional thyroid surgery, whereas the complete intermediate approach has become common in endoscopic surgery and has been applied in traditional open surgery. In this study, the primary aim was to compare the effects of two surgical approaches on postoperative parathyroid function.
This study enrolled and analyzed 270 patients with papillary thyroid cancer. The patients underwent total thyroidectomy between January 2020 and December 2022 at three medical centers and were confirmed to have papillary thyroid cancer by paraffin pathology. All the patients were diagnosed by pathologists on the basis of preoperative and postoperative specimens. The sex, age, tumor diameter, lymphatic dissection range, operation time, preoperative parathyroid hormone level, parathyroid hormone level during follow-up, etc., were analyzed. Parathyroid function was monitored at 6 months after the surgery to identify hypoparathyroidism as permanent.
The enrolled patients were divided into two groups: the complete intermediate approach surgical protocol group (the observation group) and the traditional thyroid surgery protocol group (the control group). There was no significant difference in preoperative blood parathyroid hormone levels or serum calcium levels between the observation group and the control group. However, the blood parathyroid hormone levels and blood calcium levels in the observation group were significantly greater than those in the control group on the first day after surgery. During the follow-up, these levels in all the patients in the observation group returned to the normal range, whereas four patients in the control group still exhibited decreased parathyroid hormone levels at the three-month and six-month follow-up, and thus was diagnosed as permament hypoparathyroidism.
Compared with the traditional lateral approach, the complete intermediate approach better protects parathyroid function and reduces the incidence of iatrogenic parathyroid injury.
甲状腺手术期间甲状旁腺的医源性损伤无法完全避免。外侧入路是传统甲状腺手术中最常用的手术入路，而完全中间入路在内镜手术中已很常见，并已应用于传统开放手术。在本研究中，主要目的是比较两种手术入路对术后甲状旁腺功能的影响。
本研究纳入并分析了270例甲状腺乳头状癌患者。这些患者于2020年1月至2022年12月在三个医疗中心接受了全甲状腺切除术，并经石蜡病理证实为甲状腺乳头状癌。所有患者均由病理学家根据术前和术后标本进行诊断。分析了患者的性别、年龄、肿瘤直径、淋巴结清扫范围、手术时间、术前甲状旁腺激素水平、随访期间的甲状旁腺激素水平等。术后6个月监测甲状旁腺功能，以确定甲状旁腺功能减退为永久性。
纳入的患者分为两组：完全中间入路手术方案组（观察组）和传统甲状腺手术方案组（对照组）。观察组和对照组术前血甲状旁腺激素水平或血清钙水平无显著差异。然而，观察组术后第一天的血甲状旁腺激素水平和血钙水平显著高于对照组。在随访期间，观察组所有患者的这些水平均恢复到正常范围，而对照组有4例患者在三个月和六个月随访时甲状旁腺激素水平仍降低，因此被诊断为永久性甲状旁腺功能减退。
与传统外侧入路相比，完全中间入路能更好地保护甲状旁腺功能，降低医源性甲状旁腺损伤的发生率。
