策略性甲状旁腺自体移植在甲状腺乳头状癌再次中央区淋巴结清扫中的应用  

The Application of Strategic Parathyroid Autotransplantation in The Central Lymph Node Re-dissection for Papillary Thyroid Carcinoma

作　　者：苏安平[1] 朱精强[1] 龚日祥[1] 李志辉[1] 魏涛[1] 刘枫[1] 龚艳萍[1] 马宇[1] 邹秀和[1] 雷建勇[1] SU An-ping ZHU Jing-qiang GONG Ri-xiang LI Zhi-hui WEI Tao LIU Feng Gong Yan-ping MA Yu ZOU Xiu-he LEI Jian-yong(Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China)

机构地区：[1]四川大学华西医院甲状(旁)腺疾病诊治中心,四川成都610041

出　　处：《中国普外基础与临床杂志》2016年第10期1173-1177,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技厅项目(项目编号:2016SZ0045)~~

摘　　要：目的探讨策略性甲状旁腺自体移植是否能有效减少甲状腺乳头状癌(PTC)再次中央区淋巴结清扫术后甲状旁腺功能低下的发生率。方法回顾性分析2009年1月至2015年10月期间在四川大学华西医院甲状腺外科因PTC复发(淋巴结转移)再次行单侧或双侧中央区淋巴结清扫(包括颈侧区清扫)患者的临床资料,根据初次手术是否行策略性甲状旁腺自体移植分为移植组和未移植组。统计及比较2组患者一般情况、术前血Ca2+及甲状旁腺激素水平、首次手术方式、再次手术前是否存在声带麻痹、再次手术方式和术后并发症。结果 74例PTC再次手术患者纳入研究,其中移植组35例,未移植组39例。术后1 d血Ca2+及甲状旁腺激素水平移植组明显高于未移植组(P<0.05);移植组2例患者新出现喉返神经损伤,未移植组5例新出现喉返神经损伤(5.7%比12.8%,P>0.05);移植组和未移植组分别有4例和12例出现暂时性甲状旁腺功能低下,1例和4例出现永久性甲状旁腺功能低下,2组甲状旁腺功能低下发生率差异有统计学意义(14.3%比41.0%,P<0.05)。术后病理学检查结果提示2组中央区淋巴结清扫数目分别为(2.1±1.3)枚和(1.4±0.7枚),其差异有统计学意义(P<0.05)。结论策略性甲状旁腺自体移植可有效减少PTC再次中央区淋巴结清扫术后甲状旁腺功能低下的发生,从而大大提高手术安全性及彻底性。Objective To evaluate whether strategic parathyroid autotransplantation can decrease the incidence of hypoparathyroidism after central lymph node re-dissection in patients with papillary thyroid carcinoma. Methods Data were retrospectively collected from the patients with papillary thyroid carcinoma, who had undergone unilateral or bilateral central lymph node re-dissection in the Department of Thyroid Surgery, West China Hospital of Sichuan Univer- sity between January 2009 and October 2015. The patients were divided into transplantation group and non-transplanta- tion group according to the history of strategic parathyroid autotransplantation in the primary surgery. Data concerning patient demographics （age, sex, comorbidities, the leval of Ca2＋ and parathyroid hormone, previous surgical manners and complications before reoperation）, surgical manners of reoperation, and postoperative factors （laboratory examination and postoperative complications） were collected. Results A total of 74 patients, 35 in the transplantation group and 39 in the non-transplantation group, were included in the study. Significantly higher levels of Ca2＋ and parathyroid hormone were observed in the transplantation group than in the non-transplantation group on one day after surgery （P〈0.05）. Recurrent laryngeal nerve injury newly occurred in 2 patients in the transplantation group and 5 patients in the non- transplantation group, respectively （5.7% vs. 12.8%, P〉0.05）. Transient hypoparathyroidism was documented in 4 patientsin the transplantation group and in 12 patients in the non-transplantation group. Permanent hypoparathyroidism was documented in 1 patient in the transplantation group and in 4 patients in the non-transplantation group. The incidence of hypoparathyroidism was significantly lower in the transplantation group compared with the non-transplantation group （5 vs. 16, P〈0.05）. The mean number of central lymph node identified pathologically was significantly more in the transplantation group （

关 键 词：甲状腺乳头状癌 再次中央区淋巴结清扫 策略性甲状旁腺自体移植 甲状旁腺功能低下 

分 类 号：R736.1[医药卫生—肿瘤]