甲状旁腺原位保护技术在甲状腺全切除术中的应用  

Parathyroid gland in situ protection technology in zhe application of total thyroidectomy

作　　者：王丹凤[1] 马毅[1] 邹贤[1] 朱国华[1] 梁秀清[1] 李秀龙[1] 

机构地区：[1]江苏省原子医学研究所附属江原医院 无锡市甲状腺病研究所外科,江苏无锡214063

出　　处：《中国现代普通外科进展》2015年第2期118-122,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:比较分析甲状腺全切除术中甲状旁腺的保护方法,探讨甲状旁腺原位保护技术在甲状腺全切除术中的意义。方法:选取2012年1月—2014年1月在我院行甲状腺全切除手术的患者452例,其中213例按照传统手术方案(不常规暴露甲状旁腺)进行手术(A组),239例采取甲状旁腺原位保护技术(B组);每组根据肿瘤性质分为良性组(A1、B1),恶性组(A2、B2)。分析各组患者术后第1天甲状旁腺功能减退(甲旁减)、低钙血症及症状性低钙血症的发生情况。结果:(1)A、B两组患者术后血钙及PTH与术前比较均明显下降,差异有统计学意义(P<0.05)。(2)A组患者术后第1天血甲状旁腺素(PTH)及血钙下降均值差明显高于B组,差异有统计学意义(P<0.05)。(3)A组、A1组术后第1天不良反应发生率(低钙血症、甲旁减、症状性低钙血症)分别高于B组、B1组,差异有统计学意义(P<0.05);A2组术后第1天甲旁减发生率明显高于B2组,差异有统计学意义(P<0.05),A2和B2组术后第1天低钙血症和症状性低钙血症发生率比较无显著差异(P>0.05)。结论:甲状腺切除术会引起甲状旁腺功能损伤,提高对甲状旁腺的解剖认识、注重甲状旁腺的精细被膜解剖、保护其动静脉血供能降低术后暂时性甲旁减、低钙血症和症状性低钙血症的发生率。Objective： To compare the protective methods for the parathyroid ction of technology in the total thyroidectomy. Methods： gland in the thyroidectomy, to discuss the significance of parathyroid in situ prote 452 cases ofpatients in 2012 January to 2014 January in our hospitalunderw enttotalthyroidectomy operation, of which 213 cases according to the traditionaloperation method（the routine method ofunexposure parathyroid）（group A）, 239 cases take the method of parathyroid in situ protection（group B）, each group according to the nature of the tum or was divided into the benign group（A 1, B 1）, malignantgroup（A 2, B 2）. Analysis the incidence of the firstday after the operation of hypoparathyroidism,hypocalceia and sym ptomatic hypocalcemia. Results：（1）Postoperative serum calcium and PTH were significantly decreased between A and B group compared with preoperative analysis（P〈0.05）, the difference has statistical significance;（2）the decreased mean difference of PTH and serum calcium in group A was superior to group B,the difference has statisticalsignificance（P〈0.05）,（3）To compare the postoperative incidence of adverse reactions（hypocalcemia, hypoparathyroidism, sym ptom atic hypocalcemia）： there was significantdifference between A and B group（P〈0.05）, there was significant difference for the incidence of adverse reactions（hypoparathyroidism, hypocalcemia, symptom atic hypocalcemia）between A 1 and B 1 group（P〈0.05）,the rate of postoperative hypoparathyroidism occurred had significant difference between A 2 and B 2group（P〈0.05）, the rate of hypocalcemia and sym ptom atic hypocalcemia incidence had no significant difference（P〈0.05）. Conclusion： Thyroidectomy may injury the function of parathyroid gland,im prove the anatom ic know ledge of parathyroid gland, pay attention to parathyroid with fine anatomy and the protection to the arteriovenous blood supply can reduce the incidence of tem porary hypoparathyroidism after operation, hypoca

关 键 词：甲状旁腺功能减退 甲状腺全切除术 甲状旁腺 低钙血症 

分 类 号：R582[医药卫生—内分泌] R581[医药卫生—内科学]