基于下甲状旁腺分型的计划性分离技术在甲状腺乳头状癌中央区清扫中的运用  

Application of designed dissection techniques based on the classification of inferior parathyroid gland in central neck dissection for papillary thyroid carcinoma

作　　者：侯大卫[1] 徐海娥[4] 袁冰 刘建辉 鲁一兵[2] 柳明[3] 王子君[1] 钱祝银[1] HOU Dawei;XU Hai'e;YUAN Bing;LIU Jianhui;LU Yibing;LIU Ming;WANG Zijun;QIAN Zhuyin(Department of General Surgery,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China;The School of Public Health,Nanjing Medical University,Nanjing 211166,China;Department of Endocrinology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China;Information Central,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院普通外科,江苏南京210011 [2]南京医科大学第二附属医院内分泌科,江苏南京210011 [3]南京医科大学第二附属医院信息中心,江苏南京210011 [4]南京医科大学公共卫生学院,江苏南京211166

出　　处：《中国肿瘤外科杂志》2019年第6期411-414,419,共5页Chinese Journal of Surgical Oncology

基　　金：江苏省重点研发计划(社会发展)项目(BE2015723)

摘　　要：目的探讨在甲状腺乳头状癌(PTC)行中央区淋巴结清扫(CND)中,基于下甲状旁腺(IPGs)分型的甲状腺下极区域计划性分离和IPGs策略性保护技术对IPGs的保护作用。方法选取2015年1月至2017年12月在南京医科大学第二附属医院行甲状腺全切加CND的患者159例,其中89例采用传统精细化被膜分离技术保护甲状旁腺(A组);70例在传统精细化被膜分离技术基础上加用甲状腺下极区域计划性分离和IPGs策略性保护技术(B组)。A组中行IPGs移植者18例为At组,B组中行IPGs移植者8例为Bt组。比较A、B组间和At、Bt组间术后第1天血甲状旁腺激素(PTH)和血钙水平,低PTH(<8 pg/ml)发生率和永久性甲状旁腺功能减退发生率等。结果B组术后第1天的血PTH水平高于A组[28.85(21.15,40.78)pg/ml vs.18.80(8.85,28.50)pg/ml,P<0.05],B组的术后血钙水平高于A组[(2.05±0.14)mmol/L vs.(2.00±0.15)mmol/L,P<0.05],B组术后低PTH发生率低于A组[7.1%(5/70)vs.22.5%(20/89),P<0.05]。B组永久性甲状旁腺功能减退发生率与A组差异无统计学意义[1.5%(1/66)vs.8.8%(6/68),P>0.05]。Bt组与At组的上述各项观察指标差异均无统计学意义。结论基于IPGs分型的甲状腺下极区域计划性分离和IPGs策略性保护技术在PTC行CND过程中能有效保护IPGs功能,值得临床推广应用。Objective The purpose of the present study is to introduce the techniques of the designed dissection of the area adjacent to lower pole of thyroid and strategic protection of inferior parathyroid glands(IPGs)and assess their protective effect on IPGs,which based on the classification system of IPGs,in the procedure of central neck dissection(CND)for papillary thyroid carcinoma(PTC).Methods Total 159 patients with PTC who underwent total thyroidectomy and concomitant central neck dissection from January,2015 to December,2017 in the Second Affiliated Hospital of Nanjing Medical University were enrolled.Eighty-nine patients on who the procedures were carried out with traditional meticulous fascial dissection technique before January 2017 were divided into group A.Seventy patients on who new techniques were added to meticulous fascial dissection after January 2017 were divided into group B,.Furtherly,Eighteen patients of group A on who inferior parathyroid auto-transplantation was performed were arranged into group At,meanwhile 8 patients in group B who underwent IPGs were divided into group Bt.Variables including serum intact parathyroid hormone(PTH),total calcium,the incidence of low PTH level(with a cut-off value 8 pg/ml)on the first postoperative day and the incidence of permanent hypoparathyroidism in the follow-up time were studied.Results On the first postoperative day,serum intact PTH and total calcium levels of patients in group B were significantly improved[28.85(21.15,40.78)vs.18.80(8.85,28.50)pg/ml,P<0.05]and[2.05±0.14 vs.2.00±0.15 mmol/L,P<0.05],respectively,compared with those of patients in group A.Simultaneously,the incidence of low PTH level in group B sharply dropped[7.1%(5/70)vs.22.5%(20/89),P<0.05].The incidence of permanent hypoparathyroidism decreased,but without statistical significance[1.5%(1/66)vs.8.8%(6/68)].No any significant differences of the enrolled variables were found between group Bt and group At.Conclusions The designed dissection of the area adjacent lower pole of thyroid and str

关 键 词：甲状旁腺 甲状腺肿瘤 颈淋巴结清扫术 甲状旁腺激素相关蛋白质 中央区清扫 

分 类 号：R73[医药卫生—肿瘤]