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Postoperative hypoparathyroidism after total thyroidectomy for thyroid cancer

机译：术后甲状腺切除术后甲状腺切除术治疗甲状腺癌

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ObjectivesPostoperative hypoparathyroidism (HPT) is one of the most common complications in total thyroidectomy for thyroid carcinoma. Parathyroid glands (PTGs) are at risk of being damaged during total thyroidectomy and central neck dissection mainly due to inadvertent removal, interruption of the blood supply or hematoma formation. The purpose of this study was to evaluate the efficacy of our surgical procedure to preserve for parathyroid function retrospectively and to clarify the risk factors of HPT after total thyroidectomy for thyroid cancer. Patients and methodsSixty-five patients undergoing total thyroidectomy with central neck dissection for thyroid cancer were enrolled in this retrospective study. Cancers were diagnosed as stage I in 15 patients, stage II in 24 patients, stage III in 19 patients, and stage IV in 7 patients. Lateral neck dissection and upper mediastinal dissection were simultaneously performed in 47 patients and one patient, respectively. Parathyroid glands (PTGs) were preserved in situ in 34 patients. Among 31 patients in whom PTG could not be preserved in situ, two or more PTGs were autotransplanted in 9 patients and one PTG was autotransplanted in 18 patients. PTG was not autotransplanted in 4 patients, since it could not be identified during the surgery. ResultsPostoperative transient HPT and permanent HPT were observed in 44 (68%) patients and in 12 (18%) patients, respectively. Among 34 patients in whom PTGs were preserved in situ, transient HPT and permanent HPT were observed in 17 (50%) patients and in 6 (2%) patients, respectively. Among 31 patients in whom PTG were not preserved in situ, postoperative permanent HPT was observed in all 4 patients without PTG autotransplantation, and 6 (33%) out of the 18 patients who had one PTG autotransplantation. On the other hand, none of the 9 patients who had two or more PTG autotransplantation at the time of thyroidectomy developed permanent HPT (P=0.04). The patients with large tumor (≥40mm) and/or gross extra glandular invasion had a significantly higher risk of permanent postoperative HPT compared with the patients without these pathological features (P<0.01). ConclusionsTwo or more PTG should be autotransplanted in case where PTG is not preserved in situ to prevent postoperative HPT after total thyroidectomy with central neck dissection, especially in cases of large tumor and/or gross extrathyroidal extension.
机译：玻璃抑制性低丙酮毒性（HPT）是甲状腺癌总甲状腺切除术中最常见的并发症之一。甲状旁腺（PTG）有可能在总甲状腺切除术和中央颈部剖检过程中受损，主要是由于无意中去除，中断血液供应或血肿形成。本研究的目的是评估我们的外科手术治疗甲状旁腺功能的疗效，并阐明甲状腺癌总甲状腺切除术后HPT的危险因素。在这项回顾性研究中，患者和方法和方法血清中央颈切除术治疗总甲状腺切除术的患者。癌症被诊断为15名患者，24名患者，19名患者第II期，第7名患者中的第II期和IV阶段。同时在47名患者和一名患者中同时进行侧颈夹层和上纵隔剖面。在34名患者中原位保存甲状旁腺（PTG）。在31例PTG不能以原位保存的患者中，在9名患者中，两种或更多种PTGs是固集的，18名患者中的一个PTG是自成的。 PTG在4名患者中未进行自成体，因为它无法在手术期间识别。结果术后瞬态HPT和永久性HPT分别观察到44例（68％）患者和12名（18％）患者。在34名患者中，在原位保存PTG，分别在17例（50％）患者和6名（2％）患者中观察到瞬态HPT和永久性HPT。在31例患者中，PTG不保留原位，在所有4例患者中观察到术后永久性HPT，没有PTG自聚体的患者，其中18例患者中有6例（33％），其中18名患者中有一个PTG自聚体。另一方面，在甲状腺切除术时出现了两种或更多种PTG自聚体的9例患者中没有一个，产生永久性HPT（P = 0.04）。肿瘤大（≥40mm）和/或额外的腺体患者的患者与没有这些病理特征的患者相比，永久性术后HPT的风险显着更高（P <0.01）。结论在PTG原位保存的情况下，应对PTG保存的情况下，应对甲状腺切除术后术后术后术后术后HPT，特别是在大型肿瘤和/或总脱落的情况下的情况下，术后PTG。

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