改良甲状旁腺原位保留技术在经口腔前庭腔镜甲状腺癌根治术中的应用效果  

Application effect of modified in situ parathyroid preservation technique in transoral vestibular endoscopic radical thyroidectomy for thyroid cancer

作　　者：刘艳佳 许楠 王元阳 罗勋鹏 LIU Yanjia;XU Nan;WANG Yuanyang;LUO Xunpeng(Department of Thyroid Surgery,Shenzhen People’s Hospital/the Second Clinical Medical College,Jinan University/the First Affiliated Hospital,Southern University of Science and Technology,Shenzhen 518020,China)

机构地区：[1]深圳市人民医院(暨南大学第二临床医学院,南方科技大学第一附属医院)甲状腺外科,广东深圳518020

出　　处：《新医学》2025年第2期148-154,共7页Journal of New Medicine

基　　金：国家临床重点专科建设项目;深圳市医学重点学科建设(SZXK015)。

摘　　要：目的探讨改良甲状旁腺原位保留技术在经口腔前庭腔镜甲状腺癌根治术中的应用效果。方法对2020年1月至2024年1月于深圳市人民医院接受经口腔前庭腔镜甲状腺癌根治术的105例患者进行回顾性研究。对照组采用传统甲状旁腺原位保留技术或自体移植,观察组采用改良甲状旁腺原位保留技术。比较2组治疗效果。结果2组均顺利完成手术。术前观察组与对照组的血钙和甲状旁腺激素(PTH)水平比较差异无统计学意义(均P>0.05)。术后24 h,观察组血钙水平为(2.3±0.1)mmol/L,对照组为(2.2±0.1)mmol/L,2组比较差异有统计学意义(t=-5.43,P<0.01);观察组PTH质量浓度为18.2(5.3,28.0)pg/mL,对照组为20.8(6.8,27.1)pg/mL,2组比较差异无统计学意义(t=-0.48,P>0.05)。观察组接受双侧甲状腺切除联合中央区淋巴结清扫的患者术后24 h血钙水平高于对照组(P<0.05)。观察组暂时性甲状旁腺功能减退症发生率为36.7%(18/49),对照组为50.0%(28/56);观察组术后6周PTH水平恢复率为72.2%(13/18),对照组为68.2%(15/22),2组PTH水平恢复率比较差异无统计学意义(P>0.05)。结论在经口腔前庭腔镜甲状腺癌根治术中,改良甲状旁腺原位保留技术可预防甲状旁腺功能减退,有助于改善患者术后结局。Objective To investigate the application effect of the modified in situ parathyroid preservation technique in transoral vestibular endoscopic radical thyroidectomy for thyroid cancer.Methods A retrospective analysis was carried out on 105 patients who underwent transoral vestibular endoscopic radical thyroidectomy for thyroid cancer at Shenzhen People’s Hospital from January 2020 to January 2024.The control group received traditional in situ preservation or autotransplantation of the inferior parathyroid glands,while the observation group underwent the modified in situ parathyroid preservation technique.The therapeutic effects of the two groups were compared.Results All surgeries were successfully completed in both groups.Preoperative serum calcium and parathyroid hormone(PTH)levels showed no significant differences between the observation and control groups(all P>0.05).At 24 hours postoperatively,the serum calcium in the observation group was(2.3±0.1)mmol/L,significantly higher than(2.2±0.1)mmol/L in the control group(t=-5.43,P<0.01).The PTH levels in the observation group were 18.2(5.3,28.0)pg/mL,compared to 20.8(6.8,27.1)pg/mL in the control group,with no significant difference between the two groups(t=-0.48,P>0.05).The blood calcium level in the observation group were higher than those in the control group 24 h after bilateral thyroidectomy combined with central lymph node dissection(P<0.05).The incidence of transient hypoparathyroidism was 36.7%(18/49)in the observation group and 50.0%(28/56)in the control group.At 6 weeks postoperatively,the PTH recovery rate in the observation group was 72.2%(13/18),while the control group had a PTH recovery rate of 68.2%(15/22).The difference in PTH recovery rates between the two groups was not statistically significant(P>0.05).Conclusion In transoral vestibular endoscopic radical thyroidectomy for thyroid cancer,the modified in situ parathyroid preservation technique can prevent hypoparathyroidism and contribute to the improvement of postoperative outcomes for patien

关 键 词：甲状旁腺保护 甲状旁腺识别 甲状旁腺损伤 甲状腺腔镜手术 甲状腺癌 

分 类 号：R73[医药卫生—肿瘤]