甲状腺全切除术与非甲状腺全切除术对甲状腺癌患者喉返神经损伤及术后低钙血症发生情况的影响  

Recurrent Laryngeal Nerve Injury and Postoperative Hypocalcemia after the Total Thyroidectomy and Non-total Thyroidectomy

作　　者：李莉[1] 刘壮[1] 田青[1] 拓明祥 

机构地区：[1]延安市人民医院耳鼻喉科,陕西延安716000

出　　处：《医学综述》2015年第19期3645-3647,共3页Medical Recapitulate

摘　　要：目的：探讨甲状腺全切除术与非甲状腺全切除术对甲状腺癌患者喉返神经损伤及术后低钙血症发生情况的影响。方法回顾性分析2012年2月至2014年3月在延安市人民医院进行手术的103例甲状腺癌患者的临床资料,按照不同的手术方式分为甲状腺全切除术组（ A组）42例,患侧腺叶及峡部切除组（B组）23例,患侧腺体叶及峡部加对侧大部切除术组（C组）38例。对各组患者喉返神经损伤、低钙血症的发生情况进行分析,同时对各组患者血钙含量和甲状旁腺激素分泌情况进行测定。结果 A组喉返神经损失发生率为19．0%（8/42）,B组为4．4%（1/23）,C组为2．4%（1/38）,其中A组喉返神经损失发生率高于C组（P〈0．05）。 A组低钙血症发生率为42．9%（18/42）. B组为17．4%（4/23）,C组为18．4%（7/38）,其中A组患者低钙血症发生率显著高于B、C组（均P〈0．05）。术后1-2 d三组患者血钙水平均降低,术后3 d血钙含量有所回升,其中以B组血钙含量回升最快,A组血钙含量回升最慢,组间、不同时点间、组间·不同时点间交互作用比较差异均有统计学意义（P〈0．05）。术后A组患者甲状旁腺激素分泌量显著低于B组和C组（P〈0．05）,三组患者甲状旁腺激素分泌量均显著低于术前（ P〈0．05）。结论甲状腺全切除术相对于非全切除术可增加喉返神经损伤和低钙血症发生率,且对甲状旁腺功能影响较大。Objective To investigate the effect of total thyroidectomy and non-total thyroidectomy on recurrent laryngeal nerve injury and postoperative hypocalcemia of patients with thyroid cancer. Methods Medical records of 103 patients with thyroid cancer in Yan′an People′s hospital from Feb. 2012 to Mar. 2014 were retrospectively analyzed. They were divided into total thyroidectomy group（group A） of 42 cases,the affected lobe and isthmus resection group（group B） of 23 cases,and the ipsilateral gland lobe and isthmus plus contralateral subtotal resection group（ group C） of 38 cases according to the different operating modes. Occurences of recurrent laryngeal nerve injury and hypocalcemia were analyzed,and the blood calcium levels and parathyroid hormone secretion were determined. Results The incidence of recurrent laryngeal nerve in group A was 19. 0% （8/42）,of group B was 4. 4%（1/23）,of group C was 2. 4%（1/38）,and the inci-dence of recurrent laryngeal nerve in group A was higher than that in group C（P〈0. 05）. The incidence of hypocalcemia of group A was 42. 9% （18/42）,of group B was 17. 4% （4/23）,of group C was 18. 4% （7/38）,hypocalcemia incidence of group A was significantly higher than that in group B and C（P〈0. 05）. Postoperative 1-2 d serum calcium level of each group decreased which all rebounded in the three groups, group B was the fastest, while group A was the slowest, difference between the groups, at different time points,group·time interaction were significant（P〈0. 05）. The secretion of parathyroid hormone in group A was significantly lower than that in group B and group C（P〈0. 05）,and the secretion of parathyroid hor-mone in the three groups was significantly lower than before operation（P〈0. 05）. Conclusion Compared with the non-total thyroidectomy,the total thyroidectomy increases the risk of recurrent laryngeal nerve injury and hypocalcemia,which also has greater influence on the function of parathyroid.

关 键 词：甲状腺癌 甲状腺全切除术 非甲状腺全切除术 喉返神经损伤 低钙血症 

分 类 号：R653[医药卫生—外科学]