双极电凝镊结合甲状旁腺激素快速检测对甲状腺手术中甲状旁腺的保护研究  

Study on the protection of parathyroid gland in thyroid surgery by bipolar electrocoagulation tweezers combined with rapid detection of parathyroid hormone

作　　者：颜宏锐[1] 朱焕明[1] 高兰 熊明亮 YAN Hongrui;ZHU Huanming;GAO Lan;XIONG Mingliang(First General Surgery Department of Macheng People's Hospital,Hubei Macheng 438300,China)

机构地区：[1]麻城市人民医院普外一科,湖北麻城438300

出　　处：《临床普外科电子杂志》2022年第3期32-36,共5页Journal of General Surgery for Clinicians(Electronic Version)

基　　金：2020年度武汉市第四医院与麻城市人民医院科研人才培育专项科研基金项目(KY-Y-202013)。

摘　　要：目的研究双极电凝镊结合甲状旁腺激素(parathyroid hormone,PTH)快速检测对术中甲状旁腺的保护效果。方法选择2020年2月至2021年8月麻城市人民医院收治的采用开放性甲状腺手术治疗的甲状腺肿瘤患者205例,随机分为对照组(n=102)和干预组(n=103)。对照组患者采用常规术式,手术主刀医师使用超声刀并且凭经验和肉眼判断甲状旁腺,干预组则使用双极电凝镊并实施PTH快速检测。对比两组患者的手术时间、术中出血量、术后引流量、住院总时间、PTH值、血清钙值、甲状旁腺功能低下发生率及生命质量。结果对照组患者的手术时间为(201.84±16.37)min,术后引流量为(80.46±7.69)ml,干预组患者的手术时间、术后引流量分别为(153.09±11.82)min、(51.37±4.75)ml,差异有显著性(P<0.05);两组患者术中出血量、住院总时间比较,差异无显著性(P>0.05)。术后第3天对照组患者的PTH值为(5.83±0.54)pg/ml,血清钙值为(1.90±0.15)mmoL/L,干预组患者的PTH值、血清钙值分别为(11.06±0.97)pg/ml、(2.07±0.16)mmoL/L,均显著高于对照组(P<0.05);术后1个月两组患者的PTH值、血清钙值比较,差异无显著性(P>0.05)。术后对照组患者的暂时性甲状旁腺功能低下发生率为77.45%(79/102)、永久性甲状旁腺功能低下发生率为4.90%(4/102),干预组则分别为51.46%(56/103)、0,均显著低于对照组(P<0.05)。对照组患者的甲状腺癌特异性生命质量量表得分为(19.70±1.52)分,干预组为(22.07±1.83)分,显著高于对照组(P<0.05)。结论在开放性甲状腺手术中采用双极电凝镊和PTH快速检测技术,有利于缩短手术时间,减轻机体损伤,更好地保护甲状旁腺,并且改善生活质量。Objective To study the protective effect of bipolar electrocoagulation tweezers combined with rapid detection of parathyroid hormone(PTH)on parathyroid gland during operation.Method 205 patients with thyroid tumors treated by open thyroid surgery in Macheng People's Hospital from February 2020 to August 2021 were randomly divided into control group(n=102)and intervention group(n=103).The patients in the control group were treated with routine operation.The surgeon in charge of the operation used ultrasonic scalpel and judged the parathyroid gland by experience and naked eyes.The intervention group used bipolar electrocoagulation forceps and performed rapid PTH detection.The operation time,intraoperative bleeding volume,postoperative drainage volume,total hospital stay,PTH value,serum calcium value,incidence of hypoparathyroidism and quality of life were compared between the two groups.Result The operation time and postoperative drainage volume in the control group were(201.84±16.37)min and(80.46±7.69)ml respectively,while those in the intervention group were(153.09±11.82)min and(51.37±4.75)ml respectively,with significant difference(P<0.05);there was no significant difference in the amount of intraoperative bleeding and total length of stay between the two groups(P>0.05).On the 3rd day after operation,the PTH value and serum calcium value in the control group were(5.83±0.54)pg/ml and(1.90±0.15)mmol/l respectively,and those in the intervention group were(11.06±0.97)pg/ml and(2.07±0.16)mmol/l respectively,which were significantly higher than those in the control group(P<0.05);there was no significant difference in PTH and serum calcium between the two groups one month after operation(P>0.05).The incidences of temporary hypoparathyroidism and permanent hypoparathyroidism in the control group were 77.45%(79/102)and 4.90%(4/102),while those in the intervention group were 51.46%(56/103)and 0 respectively,which were significantly lower than those in the control group(P<0.05).The score of thyroid cancer specific

关 键 词：双极电凝镊 甲状旁腺激素 快速检测 甲状旁腺 保护 

分 类 号：R73[医药卫生—肿瘤]