前臂皮下与肱桡肌甲状旁腺自体移植对预防甲状腺术后甲状旁腺功能减退症的疗效比较  

Comparison of the efficacy of forearm subcutaneous and brachioradialis parathyroid autotransplantation in the prevention of hypoparathyroidism after thyroidectomy

作　　者：齐妍 陈亮 QI Yan;CHEN Liang(Postgraduate Training Base of Fushun Central Hospital,Jinzhou Medical University,Fushun 113006,Liaoning,China;Department of Thyroid Gland and Breast Surgery,Fushun Central Hospital,Fushun 113006,Lianing,China)

机构地区：[1]锦州医科大学抚顺市中心医院研究生培养基地,辽宁抚顺1130061 [2]抚顺市中心医院甲乳外科,辽宁抚顺113006

出　　处：《中国现代医生》2024年第16期46-50,共5页China Modern Doctor

摘　　要：目的 比较前臂皮下与肱桡肌自体甲状旁腺移植术(parathyroid autotransplantation,PA)对预防甲状腺术后甲状旁腺功能减退症(hypoparathyroidism,HypoPT)的疗效及安全性。方法 选取2022年5月至2023年8月于抚顺市中心医院首次行甲状腺手术联合前臂PA的99例患者,根据患者治疗意愿将其分为暴露组(前臂皮下PA,49例)和对照组(肱桡肌PA,50例)。比较两组患者的一般临床资料和术后相关指标的差异,多因素Logistic回归分析患者术后1个月移植物存活的影响因素。结果 术后1d、术后3d,暴露组患者的血钙水平均显著高于对照组(P<0.05);术后1个月,暴露组患者的前臂移植物存活率显著高于对照组(P=0.029);暴露组患者的术后口周、指间麻木、局部淤血发生率均显著低于对照组(P<0.05);两组患者术后暂时性HypoPT发生情况比较差异无统计学意义(P>0.05)。多因素Logistic回归分析显示性别、种植部位均是术后1个月前臂移植物存活的影响因素(P<0.05)。结论 前臂皮下PA预防甲状腺术后HypoPT效果确切,是一种安全、简单且有效的治疗方式,值得临床推广应用。Objective To compare the efficacy and safety of forearm subcutaneous and brachioradialis parathyroid autotransplantation(PA) in the prevention of hypoparathyroidism(HypoPT) after thyroidectomy.Methods A total of 99 patients who underwent thyroidectomy combined with forearm PA for the first time in Fushun Central Hospital from May 2022 to August 2023 were selected.According to their treatment intention,patients were divided into exposed group(forearm subcutaneous PA,49 patients) and control group(brachioradialis PA,50 patients).The differences of general clinical data and postoperative indexes between two groups were compared,and the influencing factors of parathyroid autograft one month after surgery were analyzed by multivariate Logistic regression.Results The blood calcium level in exposed group was significantly higher than that in control group at one day and three days after surgery(P<0.05).One month after surgery,the forearm parathyroid autograft survival rate in exposed group was significantly higher than that in control group(P=0.029).The incidence of postoperative perioral,fingertip numbness and local congestion in exposed group was significantly lower than that in control group(P<0.05).There was no significant difference in occurrence of temporary HypoPT between two groups(P>0.05).Multivariate Logistic regression analysis showed that gender and implant site were the influencing factors for forearm parathyroid autograft survival one month after surgery(P<0.05).Conclusion Forearm subcutaneous PA is a safe,simple and effective way to prevent HypoPT after thyroidectomy,which is worthy of clinical promotion and application.

关 键 词：自体甲状旁腺移植术 甲状旁腺功能减退症 甲状腺手术 

分 类 号：R653[医药卫生—外科学]