Application of parathyroid typing in evaluating the degree of difficulty of in situ preservation of parathyroid gland during thyroid surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Bin , SU Anping , JIANG Ke , ZHAO Wanjun , LEI Jianyong , XING Tengfei ,  ZHU Jingqiang

Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R.China;

Corresponding author：

ZHU Jingqiang, Email: zjq-wkys@163.com

Keywords：

thyroidectomy; classification of parathyroid; preserved in situ

DOI：

10.7507/1007-9424.201612057

Video：

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Objective To evaluate whether the classification of parathyroid can be used to evaluate how difficult it is that the parathyroid glands get preserved in situ during thyroid surgery. Methods Clinical date were retrospectively collected from the patients with thyroid nodules, who had undergone the initial thyroidectomy in the Department of Thyroid Surgery, West China Hospital of Sichuan University between January 2014 and June 2016. The number of parathyroid glands was counted according to the classification of parathyroid. It got comparative analysis that the rates of parathyroid glands in situ among the different types. Results A total of 996 patients were included in the study, and 3 269 pieces of parathyroid glands were identified. The mean number of parathyroid identification was 3.3 pieces. These parathyroid glands consisted of 77.5% (2 532/3 269) type A and 22.5% (737/3 269) type B. The rate of parathyroid glands in situ was 77.1% (1 951/2 532) in type A, and 80.7% (595/737) in type B, the difference was significant (P=0.03). And the rate of parathyroid glands in situ in type A1 was significantly higher than that in type A2 (80.5%vs 21.4%,P<0.001). The parathyroid of type A3 couldn’t get preserved in situ. The rate of superior parathyroid glands in situ in type B1 was higher than that in type A1 (97.5%vs 93.7,P<0.01). But the rate of inferior parathyroid glands in type B1 was closed to that in type A1 (62.2%vs 65.7%,P=0.23), and both the rates were significant less than that in type B2 (86.0%) and in type B3 (90.2%),P_{A1vs B2}=0.001,P_{A1vs B3}<0.001,P_{B1vs B2}=0.004,P_{B1vs B3}=0.001. Conclusion The classification of parathyroid can be used to evaluate effectively how difficult it is that the parathyroid glands get preserved in situ during thyroid surgery.

Citation： WANG Bin, SU Anping, JIANG Ke, ZHAO Wanjun, LEI Jianyong, XING Tengfei, ZHU Jingqiang. Application of parathyroid typing in evaluating the degree of difficulty of in situ preservation of parathyroid gland during thyroid surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 458-463. doi: 10.7507/1007-9424.201612057 Copy

1.	中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华内分泌代谢杂志, 2012, 28(10): 779-797.
2.	田文, 郗洪庆. 甲状腺癌病人生存现状分析. 中国实用外科杂志, 2016, 36(5): 489-493.
3.	杨雷, 郑荣寿, 王宁, 等. 2010 年中国甲状腺癌发病与死亡情况. 中华预防医学杂志, 2014; 48(8): 663-668.
4.	刘玉琴, 张书全, 陈万青, 等. 中国 2003-2007 年甲状腺癌发病死亡现状及流行趋势分析. 中华流行病学杂志, 2012, 33(10): 1044-1048.
5.	Leenhardt L, Bernier MO, Boin-Pineau MH, et al. Advances in diagnostic practices affect thyroid cancer incidence in France. Eur J Endocrinol, 2004, 150(2): 133-139.
6.	Jung KW, Won YJ, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat, 2013, 45(1): 1-14.
7.	Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin, 2014, 64(1): 9-29.
8.	Dal Maso L, Lise M, Zambon P, et al. Incidence of thyroid cancer in Italy, 1991-2005: time trends and age-period-cohort effects. Ann Oncol, 2011, 22(4): 957-963.
9.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
10.	Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
11.	Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
12.	Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
13.	Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg, 2002, 26(8): 1013-1016.
14.	Lee YS, Kim SW, Kim SW, et al. Extent of routine central lymph node dissection with small papillary thyroid carcinoma. World J Surg, 2007, 31(10): 1954-1959.
15.	Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
16.	Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery, 2005, 138(6): 1095-1100, discussion 1100-1091.
17.	Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level Ⅵ lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6): 1000-1005; discussion 1005-1007.
18.	朱精强. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
19.	朱精强, 苏安平. 甲状腺结节手术治疗的合理选择. 中国实用外科杂志, 2015, 35(6): 635-639.
20.	Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands. Surgery, 1984, 95(1): 14-21.
21.	李志辉, 朱精强, 魏涛, 等. 甲状旁腺在人体中的分布特点及临床意义(附 50 例解剖研究报告). 中国普外基础与临床杂志, 2008, 15(5): 311-313, 317.
22.	Nobori M, Saiki S, Tanaka N, et al. Blood supply of the parathyroid gland from the superior thyroid artery. Surgery, 1994, 115(4): 417-423.
23.	Johansson K, Ander S, Lennquist S, et al. Human parathyroid blood supply determined by laser-Doppler flowmetry. World J Surg, 1994, 18(3): 417-420; discussion 420-421.
24.	王效军, 李应义. 52 例国人甲状旁腺的解剖学观察. 宁夏医学院学报, 2003, 25(3): 183-184.
25.	Sasson AR, Pingpank JF Jr, Wetherington RW, et al. Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Head Neck Surg, 2001, 127(3): 304-308.
26.	Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol, 2014, 12: 200.
27.	Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg, 2006, 191(3): 418-423.
28.	Dozois RR, Beahrs OH. Surgical anatomy and technique of thyroid and parathyroid surgery. Surg Clin North Am, 1977, 57(4): 647-661.

1. 中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华内分泌代谢杂志, 2012, 28(10): 779-797.
2. 田文, 郗洪庆. 甲状腺癌病人生存现状分析. 中国实用外科杂志, 2016, 36(5): 489-493.
3. 杨雷, 郑荣寿, 王宁, 等. 2010 年中国甲状腺癌发病与死亡情况. 中华预防医学杂志, 2014; 48(8): 663-668.
4. 刘玉琴, 张书全, 陈万青, 等. 中国 2003-2007 年甲状腺癌发病死亡现状及流行趋势分析. 中华流行病学杂志, 2012, 33(10): 1044-1048.
5. Leenhardt L, Bernier MO, Boin-Pineau MH, et al. Advances in diagnostic practices affect thyroid cancer incidence in France. Eur J Endocrinol, 2004, 150(2): 133-139.
6. Jung KW, Won YJ, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat, 2013, 45(1): 1-14.
7. Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin, 2014, 64(1): 9-29.
8. Dal Maso L, Lise M, Zambon P, et al. Incidence of thyroid cancer in Italy, 1991-2005: time trends and age-period-cohort effects. Ann Oncol, 2011, 22(4): 957-963.
9. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
10. Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
11. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
12. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
13. Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg, 2002, 26(8): 1013-1016.
14. Lee YS, Kim SW, Kim SW, et al. Extent of routine central lymph node dissection with small papillary thyroid carcinoma. World J Surg, 2007, 31(10): 1954-1959.
15. Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
16. Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery, 2005, 138(6): 1095-1100, discussion 1100-1091.
17. Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level Ⅵ lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6): 1000-1005; discussion 1005-1007.
18. 朱精强. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
19. 朱精强, 苏安平. 甲状腺结节手术治疗的合理选择. 中国实用外科杂志, 2015, 35(6): 635-639.
20. Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands. Surgery, 1984, 95(1): 14-21.
21. 李志辉, 朱精强, 魏涛, 等. 甲状旁腺在人体中的分布特点及临床意义(附 50 例解剖研究报告). 中国普外基础与临床杂志, 2008, 15(5): 311-313, 317.
22. Nobori M, Saiki S, Tanaka N, et al. Blood supply of the parathyroid gland from the superior thyroid artery. Surgery, 1994, 115(4): 417-423.
23. Johansson K, Ander S, Lennquist S, et al. Human parathyroid blood supply determined by laser-Doppler flowmetry. World J Surg, 1994, 18(3): 417-420; discussion 420-421.
24. 王效军, 李应义. 52 例国人甲状旁腺的解剖学观察. 宁夏医学院学报, 2003, 25(3): 183-184.
25. Sasson AR, Pingpank JF Jr, Wetherington RW, et al. Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Head Neck Surg, 2001, 127(3): 304-308.
26. Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol, 2014, 12: 200.
27. Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg, 2006, 191(3): 418-423.
28. Dozois RR, Beahrs OH. Surgical anatomy and technique of thyroid and parathyroid surgery. Surg Clin North Am, 1977, 57(4): 647-661.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of parathyroid typing in evaluating the degree of difficulty of in situ preservation of parathyroid gland during thyroid surgery

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