目的探讨微创甲状腺手术对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者术后甲状旁腺功能恢复的影响,明确恢复时间及其相关影响因素。方法采用队列研究,选取2023年1月至2024年1月在新乡医学院第一附属医院接受手术治疗的110例...目的探讨微创甲状腺手术对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者术后甲状旁腺功能恢复的影响,明确恢复时间及其相关影响因素。方法采用队列研究,选取2023年1月至2024年1月在新乡医学院第一附属医院接受手术治疗的110例PTC患者,分为微创手术组(55例)和传统开放手术组(55例)。收集术前甲状腺及甲状旁腺功能指标、术中甲状旁腺保护情况、手术时间、术后血清钙和甲状旁腺激素(parathyroid hormone,PTH)水平、术后恢复时间、低钙血症发生率、住院时间和术后疼痛评分。通过Cox回归模型分析影响恢复的因素,并对两组术后指标进行比较。结果微创手术组的甲状旁腺功能恢复时间显著短于传统组[10(8~12)d vs 17(15~21)d,P<0.001]。术后24和72 h,微创组的血清钙及PTH水平均显著高于传统组(P<0.001),低钙血症发生率明显低于传统组(15.8%vs 32.5%,P=0.005)。Cox回归分析显示,手术方式(HR=0.55,95%CI:0.33~0.91,P=0.021)、甲状旁腺保护(HR=0.58,95%CI:0.35~0.95,P=0.037)、术后早期血清钙(HR=1.32,95%CI:1.10~1.60,P=0.002)及手术时间(HR=1.12,95%CI:1.05~1.20,P=0.001)为独立影响因素。此外,微创组的住院时间(5.2 d vs 7.8 d,P<0.001)和术后疼痛评分(第1 d:2.3 vs 3.7,P<0.001;第3 d:1.5 vs 2.8,P<0.001)均显著低于传统组。结论微创甲状腺手术在甲状腺乳头状癌患者的甲状旁腺功能恢复中具有显著优势,能够缩短恢复时间,减少低钙血症发生率,降低住院时间和术后疼痛。手术方式及甲状旁腺保护是恢复时间的关键因素。展开更多
BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidec...BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.展开更多
目的探究胸甲韧带精细解剖法联合米托蒽醌注射液在甲状腺乳头状癌手术中的应用效果及有效性。方法选取2020年1月—2022年12月于连云港市第二人民医院甲乳外科术前穿刺病理确诊为甲状腺乳头状癌患者120例,采用随机数字表法均分为A、B、C ...目的探究胸甲韧带精细解剖法联合米托蒽醌注射液在甲状腺乳头状癌手术中的应用效果及有效性。方法选取2020年1月—2022年12月于连云港市第二人民医院甲乳外科术前穿刺病理确诊为甲状腺乳头状癌患者120例,采用随机数字表法均分为A、B、C 3组。A组行传统精细化被膜解剖法手术,B组在A组基础上采用米托蒽醌注射液负显影技术,C组在B组基础上加用胸甲韧带精细解剖法。收集3组患者基本信息、影像学数据,比较手术相关指标(淋巴结清扫个数、手术时长等),对比手术前后甲状旁腺激素(PTH)及钙离子(Ca^(2+))水平,同时评估术后疼痛(视觉模拟量表,VAS)及并发症情况。结果3组患者基本信息、肿瘤侵犯情况无明显差异;淋巴结清扫个数C组最多,B组次之,A组最少,且组间差异有统计学意义(P<0.017);手术时间、术中出血量、术后引流量及引流管留置时间呈相同趋势,组间差异有统计学意义(P<0.017)。住院时间方面,C组短于A、B组,手术及住院费用C组高于A组(P<0.017),与B组差异无统计学意义。术后24 h C组疼痛评分略低于A、B组(P<0.017),术后72 h 3组疼痛评分无明显差异。术后1 d,C组Ca^(2+)和PTH水平高于A组(P<0.017)。A组并发症发生率最高,B组次之,C组最低(P=0.033),A组出现1例严重并发症为长期低钙。结论胸甲韧带精细解剖法联合米托蒽醌注射液用于甲状腺癌根治术,可有效识别并保留甲状旁腺,增加淋巴结清扫数量,减少术后并发症,具有临床应用价值。展开更多
文摘目的探讨微创甲状腺手术对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者术后甲状旁腺功能恢复的影响,明确恢复时间及其相关影响因素。方法采用队列研究,选取2023年1月至2024年1月在新乡医学院第一附属医院接受手术治疗的110例PTC患者,分为微创手术组(55例)和传统开放手术组(55例)。收集术前甲状腺及甲状旁腺功能指标、术中甲状旁腺保护情况、手术时间、术后血清钙和甲状旁腺激素(parathyroid hormone,PTH)水平、术后恢复时间、低钙血症发生率、住院时间和术后疼痛评分。通过Cox回归模型分析影响恢复的因素,并对两组术后指标进行比较。结果微创手术组的甲状旁腺功能恢复时间显著短于传统组[10(8~12)d vs 17(15~21)d,P<0.001]。术后24和72 h,微创组的血清钙及PTH水平均显著高于传统组(P<0.001),低钙血症发生率明显低于传统组(15.8%vs 32.5%,P=0.005)。Cox回归分析显示,手术方式(HR=0.55,95%CI:0.33~0.91,P=0.021)、甲状旁腺保护(HR=0.58,95%CI:0.35~0.95,P=0.037)、术后早期血清钙(HR=1.32,95%CI:1.10~1.60,P=0.002)及手术时间(HR=1.12,95%CI:1.05~1.20,P=0.001)为独立影响因素。此外,微创组的住院时间(5.2 d vs 7.8 d,P<0.001)和术后疼痛评分(第1 d:2.3 vs 3.7,P<0.001;第3 d:1.5 vs 2.8,P<0.001)均显著低于传统组。结论微创甲状腺手术在甲状腺乳头状癌患者的甲状旁腺功能恢复中具有显著优势,能够缩短恢复时间,减少低钙血症发生率,降低住院时间和术后疼痛。手术方式及甲状旁腺保护是恢复时间的关键因素。
文摘BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.
文摘目的探讨不同体积结节在微波消融过程中导致喉返神经(recurrent laryngeal nerve,RLN)损伤的独立危险因素,为临床风险分层提供依据。方法回顾性分析2022年9月至2024年8月接受微波消融治疗并发生喉返神经损伤的患者,根据结节体积分为大结节组(≥500 mm 3)和小结节组(<500 mm 3),每组按12匹配无RLN损伤病例。收集4类22项参数,通过单因素及多因素logistic回归分析筛选危险因素,并构建预测模型。结果大结节组(34例损伤/82例对照)中,Z结位置(OR=3.418,95%CI:1.326~8.809)、实性结构(OR=2.795,95%CI:1.066~7.360)及前被膜间距>2 mm(OR=5.097,95%CI:1.508~17.232)为喉返神经损伤的独立危险因素。小结节组(40例损伤/104例对照)中,较高的消融功率(OR=0.904,95%CI:0.828~0.986)是喉返神经损伤的独立保护因素,结节与气管食管沟(tracheoesophagealgroove,TEG)间距≤2 mm(OR=5.717,95%CI:2.402~13.605)为喉返神经损伤的独立危险因素。结论大结节RLN损伤风险与解剖位置及结节囊实性相关,而小结节风险受能量参数及邻近神经距离影响。分层评估可优化个体化消融策略。
文摘目的探究胸甲韧带精细解剖法联合米托蒽醌注射液在甲状腺乳头状癌手术中的应用效果及有效性。方法选取2020年1月—2022年12月于连云港市第二人民医院甲乳外科术前穿刺病理确诊为甲状腺乳头状癌患者120例,采用随机数字表法均分为A、B、C 3组。A组行传统精细化被膜解剖法手术,B组在A组基础上采用米托蒽醌注射液负显影技术,C组在B组基础上加用胸甲韧带精细解剖法。收集3组患者基本信息、影像学数据,比较手术相关指标(淋巴结清扫个数、手术时长等),对比手术前后甲状旁腺激素(PTH)及钙离子(Ca^(2+))水平,同时评估术后疼痛(视觉模拟量表,VAS)及并发症情况。结果3组患者基本信息、肿瘤侵犯情况无明显差异;淋巴结清扫个数C组最多,B组次之,A组最少,且组间差异有统计学意义(P<0.017);手术时间、术中出血量、术后引流量及引流管留置时间呈相同趋势,组间差异有统计学意义(P<0.017)。住院时间方面,C组短于A、B组,手术及住院费用C组高于A组(P<0.017),与B组差异无统计学意义。术后24 h C组疼痛评分略低于A、B组(P<0.017),术后72 h 3组疼痛评分无明显差异。术后1 d,C组Ca^(2+)和PTH水平高于A组(P<0.017)。A组并发症发生率最高,B组次之,C组最低(P=0.033),A组出现1例严重并发症为长期低钙。结论胸甲韧带精细解剖法联合米托蒽醌注射液用于甲状腺癌根治术,可有效识别并保留甲状旁腺,增加淋巴结清扫数量,减少术后并发症,具有临床应用价值。
