Parathyroid in situ exposure and protection in differentiated thyroid carcinoma surgery

Abstract

Objective To study the application value of parathyrod in situ exposure and protection in differentiated thyroid cancer thyroid carcinoma(DTC)surgery. Methods 500 cases of DTC admitted from Jan. 2012 to Dec. 2014 were selected for the research. According to whether the parathyroid was anatomically exposed during the surgery, the patients were divided into experimental group(exposed group)and the control group(unexposed group). Then, depending on tumor extent and risk factors, the experimental group were divided into group E1(lateral affected glandular lobe, isthmus lobe resection and unilateral VI lymph node dissection)and E2(total or subtotal thyroidectomy and bilateral VI lymph node dissection), while the control group were divided into group C1(surgical treatment same as E1)and group C2(surgical treatment same as E2). Patients' postoperative nerve and muscle symptoms were observed, such as clinical manifestations of face, lips, hand and foot numbness or convulsions. Both preoperatively and postoperatively, patients' parathyroid hormone(PTH)and serum calcium level indicators were detected before surgery and at the 1st, 3rd, 5th, 7th, 14th and 28th day after surgery. Results The lymph node metastasis rate and number between experimental group and the control group had statistical insignificance(χ2=1.02, 0.79, P=0.14, 0.96). The recurrence rate of the 2 groups had no significant difference during the follow-up(χ2=0.23, P=0.65). Group E1 was significantly lower than Group C1 in postoperative parathyroid function decline rate, incidence of hypocalcemia and parathyroid mistakenly cut rate. Group E2 was also obviously lower than Group C2 in all these aspects. The difference had statistical significance(P<0.05). Conclusion Parathyrod in situ exposure and protection assisted by direct vision of the magnifying glass can reduce the mistakenly cut rate of parathyroid and the temporary hypoparathyroidism, which can effectively avoid the adverse effects caused by total thyroidectomy. Key words: Differentiated thyroid Cancer; Parathyroid; In situ exposure and protection