在全甲状腺切除和功能性甲状腺保护期间的偶发性副甲状腺切除术:一个回顾性队列研究
Charlotte Melot1, Gabrielle Deniziaut2,3, Fabrice Menegaux4,3
1Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de L'Hôpital, Paris, 75013, France. charlotte.melot@aphp.fr.
BMC surgery
|September 6, 2023
概括
在甲状腺手术期间偶然的副甲状腺切除术 (IP) 会增加缺血和缺甲状腺症的风险. 中枢淋巴结解剖和胸腺组织切除是IP的关键风险因素,需要外科医生意识和避免策略.
科学领域:
- 内分泌手术 内分泌手术
- 手术病理学手术病理学
背景情况:
- 在甲状腺手术期间偶发性甲状腺侧切除术 (IP) 的发生率在5.8%至29%之间.
- IP的临床意义及其相关的风险,如过渡性低血症和永久性低甲状腺症,仍然是争论的主题.
- 这项研究旨在评估可避免的IP的临床相关性,并确定其相关的风险因素.
研究的目的:
- 评估可避免的偶发性副甲状腺切除术 (IP) 与过渡性低热血症和永久性副甲状腺症相关的临床相关性.
- 在甲状腺手术期间识别和描述与偶然侧甲状腺切除术相关的危险因素.
主要方法:
- 一项回顾性队列研究,涉及1537名在2018年至2019年期间接受全甲状腺切除术的患者.
- 对病理学报告的审查,以确定偶然切除的副甲状腺,不包括甲状腺内腺.
- 在IP和对照组之间比较人口特征,风险因素和术后/PTH水平.
主要成果:
- 可避免的IP在15.2%的患者中被发现.
- 患有IP的患者表现出过渡性低血症 (17.9%对11.5%) 和永久性偏偏甲状腺症 (4.7%对1.6%) 的风险显著增加.
- 中枢淋巴结解剖 (CLND) 和偶然的胸腺组织切除是IP的独立风险因素.
结论:
- 可避免的IP具有临床意义,增加了低血症和低甲状腺症的可能性,强调了外科医生意识的必要性.
- 接受CLND的患者面临更高的IP风险,需要知情管理.
- 在CLND期间最大限度地减少或避免提摩斯组织去除对于降低IP率至关重要.
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