甲状腺切除术后甲状腺髓样癌患者低钙血症和喉返神经损伤风险增加

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中文摘要

引言： 一般来说，甲状腺髓样癌（MTC）患者接受全甲状腺切除和中央颈淋巴结清扫（CND），而只有部分分化型甲状腺癌（DTC）患者接受CND。
方法： 查询ACS NSQIP甲状腺切除靶向数据集（2016-2024），纳入接受全甲状腺切除的MTC或DTC成人患者。比较CND、侧颈淋巴结清扫（LND）率及术后并发症。
结果： 在23,337例患者中，444例（1.9%）为MTC，22,893例（98.1%）为DTC。MTC患者接受CND的比例高于DTC（72.1% vs 40.1%，p < 0.01）。MTC患者30天内低钙血症发生率更高（11.5% vs 6.8%，p < 0.01），喉返神经（RLN）损伤/功能障碍发生率也更高（10.4% vs 6.4%，p < 0.01）。在调整CND和LND后，MTC仍与低钙血症相关（OR 1.44，p = 0.03）。
结论： MTC患者术后低钙血症和RLN损伤发生率高于DTC患者。即使在考虑手术范围差异后，MTC仍与30天内低钙血症独立相关。

英文摘要

INTRODUCTION: In general, patients with medullary thyroid carcinoma (MTC) undergo total thyroidectomy and central neck dissection (CND), whereas only select patients with differentiated thyroid carcinoma (DTC) receive CND.
METHODS: The ACS NSQIP targeted thyroidectomy dataset (2016-2024) was queried for adults with MTC or DTC undergoing total thyroidectomy. Rates of CND, lateral neck dissection (LND) and postoperative complications were compared.
RESULTS: Among 23,337 patients, 444 (1.9%) had MTC and 22,893 (98.1%) had DTC. CND was performed more frequently in MTC than DTC (72.1% vs 40.1%, p < 0.01). MTC patients had higher rates of hypocalcemia within 30 days (11.5% vs 6.8%, p < 0.01) and recurrent laryngeal nerve (RLN) injury/dysfunction (10.4% vs 6.4%, p < 0.01). After adjustment for CND and LND, MTC remained associated with hypocalcemia (OR 1.44, p = 0.03).
CONCLUSION: Patients with MTC have higher rates of post-operative hypocalcemia and RLN injury than those with DTC. MTC remained independently associated with hypocalcemia within 30 days even after accounting for differences in operative extent.