甲状旁腺功能性保护在甲状腺全切除中的应用  

Application of Parathyroid Functional Protection in Total Thyroidectomy

作　　者：黄国平 蔡丽生 沈俊涛 吕陈彬 HUANG Guo-ping;CAI Li-sheng;SHEN Jun-tao;LYU Chen-bin(Zhangzhou Hospital,Fujian Medical University,Zhangzhou,Fujian Province,363000 China)

机构地区：[1]福建医科大学附属漳州市医院

出　　处：《中外医疗》2019年第29期82-84,118,共4页China & Foreign Medical Treatment

摘　　要：目的 探讨甲状旁腺功能性保护在甲状腺癌根治性全切除术中的重要性,总结预防术后甲状旁腺功能减退的技巧和方法。方法 方便选取2015年1月-2018年12月期间该院收治的诊断为甲状腺乳头状癌患者80例,全部患者均行甲状腺癌根治性全切除手术联合中央区淋巴结清扫,术中时刻注意采用各种甲状旁腺功能性保护技巧,监测术前术后血清甲状旁腺素及钙变化。分析术后甲状旁腺减退、低钙血症情况、常规病理结果及相关影响因素。结果80例患者术后45例(56.3%)血清甲状旁腺素及钙正常。16例(20.0%)血清钙降低而血甲状旁腺素正常。19例(23.8%)血清钙及血甲状旁腺素均降低,17例术后2~3周内恢复,另2例于术后1~3个月恢复,无永久性低钙血症。多因素分析显示术后甲状旁腺功能减退与肿瘤大小(χ^2=4.50,P=0.034)、淋巴结转移(χ^2=6.48,P=0.011)、中央区淋巴结清扫(χ^2=7.21, P=0.007)、术中应用纳米碳(χ^2=4.45,P=0.035)相关,与性别(χ^2=0.52,P=0.471)、年龄(χ^2=0.10,P=0.748)无关。结论在甲状腺癌行甲状腺根治性全切除病例中,注重术中甲状旁腺功能性保护,可有效减少术后甲状旁腺功能减退并发症发生率。Objective To investigate the importance of functional protection of parathyroid gland in radical resection of thyroid carcinoma,and to summarize the techniques and methods for prevention of postoperative hypoparathyroidism.Methods Convenient selected a total of 80 patients with thyroid papillary carcinoma diagnosed in the hospital from January 2015 to December 2018 were enrolled.All patients underwent radical resection of thyroid cancer combined with central lymph node dissection.A parathyroid functional protection technique to monitor changes in serum parathyroid hormone and calcium before and after surgery.Analysis of postoperative hypoparathyroidism, hypocalcemia,routine pathological findings and related influencing factors.Results Of the 80 patients,45 patients(56.3%)had normal serum parathyroid hormone and calcium.16 patients(20.0%)had lower serum calcium and normal blood parathyroid hormone.In 19 patients(23.8%),serum calcium and blood parathyroid hormone were decreased,17 patients recovered within 2-3 weeks after surgery,and the other 2 patients recovered within 1-3 months after surgery,without permanent hypocalcemia.Multivariate analysis showed postoperative hypoparathyroidism and tumor size(χ^2=4.50,P=0.034),lymph node metastasis(χ2=6.48,P=0.011),central lymph node dissection(χ^2=7.21,P=0.007),intraoperative application of nanocarbon(χ^2=4.45,P=0.035)was associated with gender(χ^2=0.52,P=0.471)and age(χ^2=0.10,P=0.748).Conclusion In the case of total thyroid radical resection of thyroid cancer,focusing on the functional protection of intraoperative parathyroid glands,can effectively reduce the incidence of postoperative complications of hypoparathyroidism.

关 键 词：甲状腺肿瘤 甲状腺乳头状癌 甲状旁腺功能减退 甲状腺全切除 低钙血症 

分 类 号：R322.5[医药卫生—人体解剖和组织胚胎学]