残余甲状腺组织皮下移位：一种用于部分甲状腺切除术的新型功能保留技术，附1年随访回顾性病例系列。

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中文摘要

背景： 良性甲状腺结节常需手术干预。在保留甲状腺功能与降低再次手术相关神经-甲状旁腺风险之间取得平衡，是一项尚未解决的临床挑战。本研究旨在探讨在切除良性甲状腺肿瘤后，将残余正常甲状腺组织移位至皮下空间的可行性。传统甲状腺切除术通常损害原生甲状腺功能并导致术后甲状腺功能减退。留在颈部的残余甲状腺组织使监测复杂化，并增加二次手术中喉返神经和甲状旁腺的风险。尽管皮下移位可能保留甲状腺功能并简化随访，但其有效性和安全性仍需进一步验证。
方法： 这项单中心回顾性分析纳入106例符合条件的良性甲状腺肿瘤患者，他们在2022年5月至2025年5月期间接受了部分甲状腺切除术并残余腺体移位。94例患者接受单侧切除术，12例接受双侧切除术。残余正常组织通过胸锁乳突肌-胸骨舌骨肌交界处转移至浅层皮下肌肉间隙。预设结局包括术后甲状腺功能和超声确认的移植物存活。甲状腺功能通过化学发光法测定，颈部超声用于评估移植物状态。评估安排在术后1个月和1年。
结果： 所有106例入组患者均完成了术后1个月随访，并且全部参加了1年随访。队列包括94例接受单侧部分甲状腺切除术的患者和12例接受双侧部分甲状腺切除术的患者。1个月时，数名患者观察到轻度局限性前颈部肿胀。超声确认了移位甲状腺组织的位置和大小。所有94例单侧切除术患者的甲状腺功能正常。在12例双侧切除术患者中，5例出现甲状腺功能减退并需要左甲状腺素补充。术后1年时，颈部外观无异常，超声显示移位组织内无异常病变。5例患者在激素替代治疗下甲状腺功能恢复正常。其余101例患者维持正常甲状腺功能，无需左甲状腺素治疗。
结论： 基于这项单中心、非对照回顾性病例系列的1年随访结果，在良性肿瘤部分甲状腺切除术中，残余正常甲状腺组织的皮下移位在该患者队列中对于保留短期甲状腺功能和维持满意美容效果是可行且有效的。减少再次手术中喉返神经和甲状旁腺损伤的潜在益处仍属理论性，无法用当前有限数据验证；需要更长期随访和对照研究来确认其长期有效性和安全性。

英文摘要

BACKGROUND: Benign thyroid nodules frequently require surgical intervention. Balancing thyroid‑function preservation and re‑operation‑related neuro‑parathyroidal risk represents an unmet clinical challenge. This study aimed to investigate the feasibility of translocating residual normal thyroid tissue into the subcutaneous space after resection of benign thyroid tumors. Conventional thyroid resection commonly compromises native thyroid function and leads to postoperative hypothyroidism. Residual thyroid tissue retained in the neck complicates surveillance and increases risks to the recurrent laryngeal nerve and parathyroid glands during secondary surgery. Although subcutaneous translocation may preserve thyroid function and simplify follow-up, its efficacy and safety require further verification.
METHODS: This single-center retrospective analysis included 106 eligible patients with benign thyroid tumors who underwent partial thyroidectomy with residual gland translocation between May 2022 and May 2025. Ninety-four patients underwent unilateral resection, and 12 underwent bilateral resection. Residual normal tissue was transposed into the superficial subcutaneous muscular space through the sternocleidomastoid-sternohyoid muscle junction. Prespecified outcomes comprised postoperative thyroid function and ultrasound-confirmed graft viability. Thyroid function was measured by chemiluminescence assay and neck ultrasonography was used to assess graft status. Evaluations were scheduled at 1 month and 1 year postoperatively.
RESULTS: All 106 enrolled patients completed the 1-month postoperative follow-up, and all attended the 1-year follow-up. The cohort consisted of 94 patients receiving unilateral partial thyroidectomy and 12 receiving bilateral partial thyroidectomy. Mild localized anterior neck swelling was observed in several patients at 1 month. Ultrasound confirmed the location and size of translocated thyroid tissue. Thyroid function was normal in all 94 patients with unilateral resection. Among the 12 patients with bilateral resection, 5 developed hypothyroidism and required levothyroxine supplementation. At 1 year postoperatively, cervical appearance was unremarkable, and ultrasound showed no abnormal lesions in transposed tissue. Thyroid function normalized under hormone replacement in the 5 patients. The remaining 101 patients sustained normal thyroid function without levothyroxine therapy.
CONCLUSIONS: Based on the 1-year follow-up outcomes of this single-center, uncontrolled retrospective case series, subcutaneous translocation of residual normal thyroid tissue during partial thyroidectomy for benign tumors is feasible and effective in preserving short-term thyroid function and maintaining satisfactory cosmetic outcomes in this patient cohort. The potential benefit of reducing recurrent laryngeal nerve and parathyroid gland injury during reoperation remains theoretical and cannot be verified with current limited data; longer-term follow-up and controlled studies are required to confirm its long-term efficacy and safety.