| Objective:To compare the thoroughness of lymph node dissection and the effect on parathyroid function between central lymph node dissection only in the area below the inferior thyroid artery and traditional central lymph node dissection.So we try to reduce the incident rates of hypoparathyrodism,enhance patients’ quality of life,and increase patients’ satisfaction with medical services through research to find ways to better protect the parathyroid glands.Methods:Research objections:Patients with papillary thyroid microcarcinoma(PTMC)admitted to our department from November 2021 to March 2022 were included in this study.Research methods: The selected subjects were split at random into two groups.The patients were numbered/marked according to the sequence of admission.The patients with odd number were included in the experimental group,and the patients with even number were included in the control group.Informed consent was obtained from the patients and their family members,after this,they needed to sign the informed consent form before enrollment,which was authorized by the ethics committee of our hospital,but the patient did not know which group he/she was in.After patients rolled into groups,according to the group,the same doctor team utilized the homogeneous thyroid carcinoma operation method,which was named the anatomy of the thyroid capsule technology to finish the operation.The surgeon only ligatured the thyroid artery’s branch.In the experimental group,the inferior thyroid artery was first located and marked during thyroid lobectomy,and in the process of central lymph nodes dissection,only the area below the inferior thyroid artery was dissected,and the paratracheal central area above the inferior thyroid artery was not dissected.The control group was dissected according to the traditional central lymph nodes dissection.Annotation:(the anatomy of the thyroid capsule technology means that the operation principle of separating and ligaturing one by one of the small blood vessels entering and leaving the thyroid gland close to the real dorsal membrane of the thyroid gland).Observational index:(1)General clinical information of patients in the two groups are shown in Table 1a,2a;(2)The operation related conditions(operation time,postoperative drainage volume,hospital length of stay)are observed,as shown in Table 1b,2b;(3)Postoperative pathological conditions(total number of dissected cervical central lymph nodes,number of positive lymph nodes and positive lymph nodes metastasis ratio,number of lesions,whether the tumor invaded the capsule,whether it was combined with Hashimoto’s thyroiditis)are shown in Table 1c,2c;(4)PTH levels before and after surgery(1 day,3 days,1 month and 6 months),preoperative(serum free calcium,magnesium,phosphorus ion concentration)and serum free calcium ion levels before and after surgery(1 day,3 days,1 month)are shown in Tables 1d,1e and 2d,2e;(5)the incidence of postoperative hypoparathyroidism and hypocalcemia are shown in table 1f,2f;(6)the occurrence of other postoperative complications(hoarseness,postoperative bleeding,incision infection,etc.)are shown in table 1g,2g.Results:There were 172 patients with PTMC(102 patients with unilateral lesions and 70 patients with bilateral lesions).According to unilateral or bilateral lesions,patients were divided into two groups: group A and group B.Patients with bilateral lesions underwent total thyroidectomy combined with bilateral central neck lymph node dissection(patients with bilateral lesions were further divided into two groups according to different lymph node dissection methods,and those who underwent traditional lymph node dissection were marked as group A1,and those who underwent only dissection under the inferior thyroid artery were marked as group A2,with 35 patients in each group).Patients with unilateral lesions underwent unilateral lobectomy of thyroid gland with isthmus resection and ipsilateral central neck lymph node dissection(patients with unilateral lesions were further divided into two groups according to different lymph node dissection methods.Those who underwent traditional lymph node dissection were marked as group B1,and those who underwent only dissection under the inferior thyroid artery were marked as group B2,with 51 patients in each group).There was no obvious distinction in gender and age between A1 group and A2 group compared with general clinical data(P>0.05).There was no obvious distinction in postoperative pathological characteristics(whether there was Hashimoto’s thyroiditis,whether the tumor invaded the capsule,single/multiple foci)between the two groups(P>0.05).There was no obvious distinction in the total number of cervical dissected lymph nodes,the number of positive lymph nodes and the rate of lymph nodes metastasis between the two groups(P>0.05).There was no obvious distinction in operation time between the two groups(P>0.05).There was statistically remarkable difference in the length of hospital stay and postoperative drainage volume(P<0.05).The length of impatient days and postoperative drainage volume of A2 were less than those of A1.There was no obvious distinction in preoperative PTH and serum free calcium,magnesium and phosphorus ion levels between the two groups(P>0.05).There was statistically remarkable difference in PTH level between the two groups on the 1st,3rd,1st month and 6 month after operation(P<0.05).The PTH level in group A1 was lower than that in group A2.There was statistically significant distinction in serum free calcium level between the two groups on the 1st and 3rd day after operation(P<0.05),and the level of calcium in group A1 was lower than that in group A2.There was no obvious distinction in free calcium ion level between the two groups at 1 month after operation(P>0.05).Postoperative hypocalcemia,temporary hypoparathyroidism and permanent hypoparathyroidism occurred in both groups,compared to the probability of two groups,there was no statistically significant distinction(P>0.05),the incidence of postoperative persistent hypoparathyroidism and symptomatic hypocalcemia of two groups compared,the difference was statistically remarkable(P<0.05);The incidence of persistent hypoparathyroidism and symptomatic hypocalcemia in group A2 was lower than that in group A1.There was no obvious difference in other postoperative complications(postoperative bleeding,hoarseness,and etc)between the two groups(P>0.05).There was no obvious difference in gender,age and lesion side between group B1 and B2(P>0.05).There was no significant distinction in postoperative pathological characteristics(whether there was Hashimoto’s thyroiditis,whether the tumor invaded the capsule,single/multiple foci)between the two groups(P>0.05).There was no obvious difference in the total number of dissected cervical central lymph nodes,the number of positive lymph nodes and the rate of its metastasis between the two groups(P>0.05).There was no obvious distinction in operation time between the two groups(P>0.05).There was remarkable difference in the length of hospital stay and postoperative drainage volume(P<0.05).The length of impatient days and postoperative drainage volume in group B2 were less than those in group B1.There was no significant distinction in preoperative PTH and serum free calcium,magnesium and phosphorus ion levels between the two groups(P>0.05).There was statistically obvious difference in PTH level between the two groups on the 1st,3rd day,1st month and 6th month after operation(P<0.05).The PTH level in group B1 was lower than that in group B2.There was remarkable difference in serum calcium level between the two groups on the 1st and 3rd day after operation(P<0.05),and the level of calcium in group B1 was lower than that in group B2.There was no obvious difference in calcium ion level between the two groups at 1 month after operation(P>0.05).There was significant distinction in the number of temporary hypoparathyroidism,hypocalcemia and sympotomatic hypocalcemia between the two groups after operation(P<0.05),the incidence of temporary hypoparathyroidism,hypocalcemia and symptomatic hypocalcemia in group B2 was lower than that in group B1.There was no obvious distinction in the number of persistent hypoparathyroidism and permanent hypoparathyroidism(P>0.05).There was no significant distinction in other postoperative complications(postoperative bleeding,hoarseness,and etc)between the two groups(P>0.05).Conclusion:For unilateral or bilateral PTMC patients with clinical negative lymph node,there is no obvious difference in the total retrieved number of lymph nodes,the number of positive lymph nodes and the rate of lymph nodes metastasis between the ways of central region is performed only under the inferior thyroid artery and the traditional central region lymph node dissection in the prophylactic dissection of lymph nodes.Patients in the group with only lymph node dissection below inferior thyroid artery have shorter hospital stay and lower postoperative drainage volume,lower incidence of temporary/persistent postoperative hypoparathyroidism and symptomatic hypocalcemia,which reduce the postoperative discomfort,and the incidence of hypoparathyroidism,hypocalcemia and symptomatic hypocalcemia after total thyroidectomy plus bilateral central lymph node dissection is higher than that of unilateral lobectomy with isthmus resection plus ipsilateral central lymph node dissection,suggesting that patients with bilateral lesions in PTMC are more likely to have hypoparathyroidism and symptomatic hypocalcemia. |
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