腔镜甲状腺癌根治术联合甲状旁腺自体移植术对甲状旁腺功能恢复的影响  

Endoscopic radical thyroidectomy combined with parathyroid autotransplantation on recovery of parathyroid function

作　　者：张琪 王泽升 高金伟 章婧 张宇鹏 屈坤鹏[3] Zhang Qi;Wang Ze-Sheng;Gao Jin-Wei;Zhang Jing;Zhang Yu-Peng;Qu Kun-Peng(The First Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou,Gansu 730000,China;Department of General Surgery,Kangle Hospital,Lanzhou,Gansu 730000,China;General Surgery Department No.6,Gansu Provincial People’s Hospital,Lanzhou,Gansu 730000,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]康乐医院普外科,甘肃兰州730000 [3]甘肃省人民医院普外六科,甘肃兰州730000

出　　处：《解放军医学杂志》2023年第4期437-444,共8页Medical Journal of Chinese People's Liberation Army

基　　金：甘肃省自然科学基金(145RJZA116)。

摘　　要：目的探讨腔镜甲状腺癌根治术联合甲状旁腺自体移植术对术后甲状旁腺功能恢复的影响。方法回顾性纳入2019年1月-2021年4月甘肃省人民医院普外科收治的323例行腔镜甲状腺癌根治术患者的临床资料,根据术中是否行选择性甲状旁腺自体移植术分为移植组(n=171)与非移植组(n=152)。记录两组患者术前及术后1 d、1周、1个月、3个月、6个月、12个月的体循环甲状旁腺激素(PTH)、Ca2+浓度及甲状旁腺功能减退发生情况,收集移植患者双臂肘窝静脉PTH浓度。采用logistic回归分析甲状腺术后甲状旁腺功能减退的危险因素。结果移植组暂时性甲状旁腺功能减退发生率高于非移植组(33.33%vs.23.03%),永久性甲状旁腺功能减退率低于非移植组(0.58%vs.5.26%),差异有统计学意义(P=0.007)。移植组术后1周至术后12个月的PTH浓度均高于非移植组,差异有统计学意义(P<0.001)。移植患者术后1周至术后12个月移植侧肘窝静脉PTH浓度明显高于非移植侧,差异有统计学意义(P<0.001)。术后12个月,移植组甲状旁腺PTH分泌功能恢复至术前的85.42%,非移植组恢复至术前的67.60%。单因素logistic回归分析显示,移植(OR=1.671,95%CI 1.020~2.738,P=0.041)和桥本甲状腺炎(OR=1.925,95%CI 1.138~3.259,P=0.015)是甲状腺术后暂时性甲状旁腺功能减退的危险因素,移植(OR=0.106,95%CI 0.013~0.857,P=0.035)是永久性甲状旁腺功能减退的保护因素。多因素logistic回归分析显示,移植(OR=1.736,95%CI 1.044~2.887,P=0.034)和桥本甲状腺炎(OR=1.903,95%CI1.111~3.258,P=0.019)是暂时性甲状旁腺功能减退的危险因素,移植(OR=0.101,95%CI0.012~0.839,P=0.034)是永久性甲状旁腺功能减退的保护因素。结论在腔镜甲状腺癌根治术中,甲状旁腺自体移植是预防永久性甲状旁腺功能减退的有效策略,但同时可导致术后短期内甲状旁腺功能减退;尽可能在原位保留上极甲状旁腺的基础上,选择性移植术�Objective To explore the effect of endoscopic radical thyroidectomy combined with parathyroid autotransplantation on the recovery of postoperative parathyroid function.Methods The clinical data of 323 patients undergoing endoscopic radical resection of thyroid carcinoma in the General Surgery Department of Gansu Provincial People's Hospital from January 2019 to April 2021 were retrospectively analyzed and divided into transplant group(n=171)and non-transplant group(n=152)according to whether combined with selective parathyroid.The incidence of circulating parathyroid hormone(PTH),Ca2+concentration and hypoparathyroidism were recorded before surgery and 1 day,1 week,1 month,3 months,6 months and 12 months after surgery in both groups,and the PTH concentration in the elbow fossa veins of both arms were collected in the transplant patients.Risk factors for hypoparathyroidism after thyroid surgery were analyzed using logistic regression.Results The incidence of transient hypoparathyroidism was higher,while of permanent hypoparathyroidism was lower in transplant group than in non-transplant group(33.33%vs.23.03%;0.58%vs.5.26%),the differences were significant(P=0.007).The PTH concentrations were significantly higher in transplant group than in non-transplant group from 1 week to 12 months after surgery with statistically significant difference(P<0.001).The PTH concentration in vein of transplant side cubital fossa was significantly higher from 1 week to 12 months after surgery in transplant group than in non-transplant group,and the differences were statistically significant(P<0.001).Twelve months after surgery,PTH secretion function in transplant group and non-transplant group had recovered to 85.42%and 67.60%of preoperative baseline,respectively.Univariate logistic regression analysis showed that transplantation and Hashimoto's thyroiditis were the risk factors for temporary hypoparathyroidism after thyroid surgery(OR=1.671,95%CI 1.020-2.738,P=0.041;OR=1.925,95%CI 1.138-3.259,P=0.015),and transplantation was a prote

关 键 词：腔镜甲状腺癌根治术 选择性甲状旁腺自体移植术 暂时性甲状旁腺功能减退 永久性甲状旁腺功能减退 中央区淋巴结清扫 

分 类 号：R653[医药卫生—外科学]