甲状腺癌行甲状腺全切除术后甲状旁腺激素水平变化的影响因素研究  

Influential Factors of Changes in Parathyroid Hormone Levels after Thyroidectomy for Thyroid Cancer

作　　者：陈金剑 刘小华[1] 陈婷 CHEN Jin-jian;LIU Xiao-hua;CHEN Ting(Department of Head and Neck Surgery,Second Hospital of Longyan City,Longyan,Fujian Province,364000 China)

机构地区：[1]福建省龙岩市第二医院头颈乳腺外科

出　　处：《中外医疗》2019年第29期63-65,72,共4页China & Foreign Medical Treatment

摘　　要：目的 探讨甲状腺全切除术(TT)治疗甲状腺癌后甲状旁腺激素(PTH)水平变化的影响因素。方法 方便选取2017年1月-2019年1月该院接收的100例甲状腺癌患者,均行TT治疗,于术前、术后24 h内对其血清PTH水平进行监测,并分析导致术后血清PTH出现变化的因素。结果 结合术后血清PTH水平,将患者分为A组(PTH正常)55例,B组(PTH降低)42例,C组(PTH升高)3例。3组基本资料与超声刀使用率、性别、年龄相比,差异无统计学意义(P>0.05);3组手术方式(A组TT7例、TT+单侧中央区淋巴结清扫48例、TT+双中央区以及侧颈淋巴结清扫0例;B组分别为0例、27例和15例;C组1例、2例和0例)、桥本甲状腺炎合并率(A组7.27%、B组23.81%、C组33.33%)及甲状旁腺原位保留率(A组96.36%、B组38.10%和C组100.00%)对比,差异有统计学意义(χ^2=6.264,P=0.045;χ^2=4.254,P=0.006;χ^2=7.156,P=0.023);59例术后出现暂时性低钙血症,经为期30 d的随访发现,无永久性低钙血症。结论影响TT后甲状旁腺功能的重要因素为甲状旁腺原位保留和中央区淋巴结清扫,中央区淋巴结清扫时需仔细分离,移植或原位保留两枚以上的甲状旁腺,并提高对伴桥本甲状腺炎患者的重视力度,以降低术后甲旁减发生率。Objective To investigate the influencing factors of thyroidectomy(TT)in the treatment of parathyroid hormone(PTH)levels after thyroid cancer.Methods One hundred patients with thyroid cancer who were admitted to the hospital from January 2017 to January 2019 were convenient selected and treated with TT.The serum PTH levels were monitored before and 24 hours after surgery,and the serum PTH was analyzed.Results Combined with postoperative serum PTH levels,patients were divided into group A(PTH normal)in 55 patients,group B(PTH decreased)in 42 patients,and group C(PTH in elevated)in 3 patients.There were no significant differences between the three groups of basic data and the use rate,gender,and age of the ultrasonic scalpel(P>0.05);three groups of surgical methods(In group A,TT 7 cases,TT+unilateral central lymph node dissection in 48 cases,TT+double central area and lateral neck dissection in 0 cases;group B in 0 cases,27 cases and 15 cases;group C in 1 case,2 cases and 0 cases),Hashimoto's thyroiditis combined rate(7.27%in group A,23.81%in group B,33.33%in group C)and in situ retention of parathyroid(96.36%in group A,38.10%in group B and 100.00%in group C).There were statistical differences(χ^2=6.264,P=0.045;χ^2=4.254,P=0.006;χ^2=7.156,P=0.023);59 cases of transient hypocalcemia occurred after 30 days of follow-up,no permanent hypocalcemia.Conclusion The important factors affecting the function of parathyroid gland after TT are parathyroid gland in situ preservation and central lymph node dissection.The central lymph node dissection should be carefully separated,transplanted or retained in situ for more than two parathyroid glands,and improved the attention of patients with Hashimoto's thyroiditis,and reduced the incidence of postoperative hypothyroidism.

关 键 词：甲状旁腺激素 甲状腺切除术 甲状腺肿瘤 

分 类 号：R5[医药卫生—内科学]