甲状腺癌中央区淋巴结清扫和术后甲状旁腺功能减退  

Central lymph node dissection in thyroid carcinoma and postoperative hypoparathyroidism

作　　者：沈晓卉[1] 吕春晖[1] 陈海珍[1] 薛松[1] 丁家增[1] 陈曦[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《外科理论与实践》2016年第4期312-317,共6页Journal of Surgery Concepts & Practice

摘　　要：目的:研究不同甲状腺手术方式,尤其是中央区淋巴结清扫的作用以及术后甲状旁腺功能减退的发生。方法:连续收集同组医师操作的100例甲状腺手术病例。按手术方式分为6组:单侧甲状腺切除组12例,单侧甲状腺切除加单侧中央区颈淋巴结清扫组13例,双侧甲状腺切除组7例,双侧甲状腺切除加单侧中央区颈淋巴结清扫组32例,双侧甲状腺切除加双侧中央区颈淋巴结清扫组24例,双侧甲状腺切除加双侧中央区及患侧颈侧区颈淋巴结清扫组12例。分析其治疗结果及并发症发生率,尤其是对甲状旁腺功能的影响。结果:100例中单纯甲状腺乳头状癌74例,其中p N136例(48.6%)。除单侧甲状腺切除术外,其他手术方式术后第1天甲状旁腺激素水平均明显下降,但多可在术后1个月恢复至正常范围。75例共出现41例暂时性和4例永久性甲状旁腺功能减退(甲旁减),其发生率分别为54.7%和5.3%。行双侧甲状腺切除术病例暂时性甲旁减发生率显著高于单侧术式组,但各组间永久性甲旁减发生率无统计学差异,通过适当口服钙剂和维生素D,病人均无明显低钙症状。结论:对甲状腺乳头状癌病人行中央区淋巴结清扫,有积极而肯定的意义。对甲状旁腺功能影响多为暂时。Objective To investigate the effect of surgical treatment in thyroid carcinoma, especially central lymph node dissection and postoperative hypoparathyroidism. Methods One hundred patients with thyroid carcinoma resection by same surgeon group were divided into 6 groups according to surgery. Twelve patients were in lobectomy group, 7 patients in total thyroidectomy group, 13 in group of lobectomy with unilateral central lymph node dissection, 32 in group of total thyroidectomy with unilateral central lymph node dissection, 24 in group of total thyroidectomy with bilateral central lymph node dissection, and 12 in group of total thyroidectomy with lymph node dissection of bilateral central and unilateral late-ral cervical region. The surgical results and morbidity including hypoparathyroidism were analyzed. Result There were 74 cases with papillary thyroid carcinoma including p N136 cases（48.6%）. Parathyroid hormone levels decreased significantly on postoperative day 1 in all except lobectomy group and restored to normal after 1 month of surgery. There were 41 cases（54.7%） with temporary and 4 cases（5.3%） with permanent hypoparathyroidism in 75 patients performing total thyroidec-tomy. Temporary hypoparathyroidism incidence of the patients in total thyroidectomy group was significantly more than that in lobectomy group. However, no difference was present in the incidence of permanent hypoparathyroidism between groups. With treatment of appropriate oral calcium and vitamin D, no patients had any obvious hypocalcemia symptoms.Conclusions It is certainly useful to perform central lymph node dissection for patients with papillary thyroid carcinoma.Hypoparathyroidism is found to be mostly temporary.

关 键 词：甲状腺手术 甲状腺癌 甲状旁腺素 甲状旁腺功能减退 

分 类 号：R736.1[医药卫生—肿瘤]