Effect Of Prioritizing Localizing IPTG By TBPL And Excising Total Thyroid Mesangium On Surgery In Patients With PTC

Objective:To explore the protection of the parathyroid glands and thorough dissection of the central lymph nodes through prioritizing localizing IPTG by TBPL and excising total thyroid mesangium on surgery in patients with PTC.Methods:A retrospective analysis was performed on the clinical data of PTC patients undergoing total thyroidectomy with central neck dissection(CND)from February 2014 to October 2020 in the Department of Thyroid Surgery,the First Hospital of Jilin University.After screening by inclusion criteria and exclusion criteria,180 patients were involved and divided into group A(conventional surgery group)and group B(total thyroid mesangectomy group via TBPL approach).Review and record patient clinical data,including gender,age,multifocal disease,Hashimoto thyroiditis,extrathyroidal invasion,membrane,maximum tumor diameter,follow-up time,parathyroid hormone level on day 1 postoperatively,parathyroid hormone level at 1 month postoperatively,parathyroid hormone level at 1 year postoperatively,parathyroid tissue in postoperative pathology,the total number of lymph nodes removed(LNY),central lymph node positive number(the total number of positive nodes removed,PLN),the percentage of positive lymph nodes to the number of lymph nodes removed(PLN%),number of days with drainage tube postoperatively,recurrence,postoperative hypocalcemia symptoms,hoarseness,choking after drinking water.The hypoparathyroidism of the two groups on the first postoperative day,one month after surgery,and one year after surgery was analyzed,and whether there was parathyroid tissue in the postoperative pathology.To analyze whether there were differences in LNY,PLN,PLN%between the two groups;The two groups were analyzed whether the patients had recurrence after surgery,the number of days with drainage tubes after surgery,whether there were symptoms of hypocalcemia,hoarseness,and choking after drinking water.Results:Among the 180 patients,71 patients had hypoparathyroidism on the first postoperative day(39.4%),43.2%of patients in group A and 36.4%in group B had hypoparathyroidism on the first postoperative day,patients in group A had a greater chance of hypoparathyroidism on the first postoperative day,and there was no significant difference between the two groups.7 patients had hypoparathyroidism(3.9%)one month after surgery,all of which were from group A,and the difference between the two groups was statistically significant(P=0.009).There was no permanent hypoparathyroidism in either group.There was no difference in the presence of parathyroid tissue in postoperative pathology between the two groups,including 11 cases(13.6%)in group A and 12 cases(12.1%)in group B.There was no significant significance in the number of days with drainage tubes in the two groups after surgery,and the days with tubes in group A(3.15±0.527)days and group B(3.20±0.685)days.The median LNY in group A was 6,and the median of group B was 8,compared with group A,group B had more LNR,the difference between the two groups was statistically significant(P=0.011),there was no significant difference in PLN and PLN%in the two groups,the median PLN was 1 and 1,the median PLN was 0.07%and 0.00%,respectively,and there was no recurrence in both groups during the follow-up period,and there was no hoarseness,cough and symptoms of hypocalcemia after 1 month after surgery.Conclusions:The operation of TBPL locating the inferior parathyroid gland(IPTG)as a precursor and excising total thyroid mesangium can reduce the occurrence of temporary hypoparathyroidism to a certain extent on the basis of thorough dissection of central lymph nodes.