不同术式甲状腺手术对甲状旁腺素和血钙的影响  

The changes of parathyroid hormone and serum calcium in different modes of thyroid surgery

作　　者：范西红[1] 贺青卿[1] 李霞[1] 庄大勇[1] 范子义[1] 郑鲁明[1] 席晨辉[1] 段松建[1] 庞冰川[1] 

机构地区：[1]山东济南军区总医院甲状腺乳腺外科,250031

出　　处：《中华内分泌外科杂志》2011年第4期247-249,279,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的探讨甲状腺不同术式术后甲状旁腺素（PTH）和血钙的变化，总结预防甲状腺术后甲状旁腺功能低下（甲旁减）、低钙血症等的发生。方法检测2006年8月至2009年12月470例不同术式甲状腺手术术前和术后第1天血清门H和血钙，比较其变化，并按手术范围大小及相近似分为7组比较不同范围手术术后PTH和血钙的变化，行统计学分析。结果甲状腺不同术式手术前后血清PTH、血钙（除一侧和双侧腺叶部分切除外）差异有统计学意义（P〈0．05）。双侧次全切、一叶加对侧次全切，尤其是甲状腺近全切、全切术后PTH和血钙下降幅度、低血钙症发生率及发生临床症状者与一叶切除、一叶加对侧部分或大部切除者差异有统计学意义（P〈0．05）。颈淋巴清扫术后PTH和血钙下降幅度、低PTH和低钙血症发生率及发生临床症状者和未清扫者间差异有统计学意义（P〈0．05）。结论各种术式甲状腺手术均可影响甲状旁腺功能，手术范围越大术后并发甲旁减可能越大。预防甲状腺术后甲旁减的发生，除手术操作外，掌握手术指征、选择合理术式，酌情预防性使用维生素D和钙制剂。Objective To investigate the changes of serum concentration of parathyroid hormone （PTH） and calcium after thyroid surgery and compare the changes among different modes of operation. Methods From Aug. 2006 to Dec. 2009, 470 patients accepted thyroid surgery. The serum concentration of PTH and calcium in different groups was measured and compared before and 1 day after surgery. According to the extent and similarity of the surgery, patients were classified into 7 groups and they were compared in terms of postoperative changes of PTH and serum calcium. Statistical analysis was performed. Results The serum concentration of PTH and calcium decreased significantly after surgery in all patients except for those receiving unilateral and bilateral partial thyroidectomy. Compared with unilateral lobectomy, surgeries such as bilateral subtotal thyroidectomy, unilateral thyroidectomy with contralateral subtotal thyroidectomy, bilateral near-total thyroidectomy and total thyroidectomy resulted in more dramatic decreases of serum concentration of PTH and calcium and higher incidence of hypocalcemia （ P 〈 0.05 ）. The comparison between patients receiving CLND or not had the same result. Conclusions Almost all kinds of thyroid surgery affect the parathyroid function. The wider the surgery, the higher the possibility of postoperative hypoparathyroidism. The indications and criteria of different types of thyroid surgery are essen- tial for hypoparathyroidism prevention. In some cases, vitamin D and calcium are recommended for preventive purpose.

关 键 词：甲状腺手术 并发症 甲状旁腺素 低钙血症 

分 类 号：R653[医药卫生—外科学]