改良Miccoli手术在全甲状腺切除术中对甲状旁腺保护研究

Comparion of three kinds of operation in protection of parathyroid gland in the thyroidectomy

目的甲状腺乳头状癌行传统全甲状腺切除术后常见并发症为甲状旁腺功能低下,可引起严重低钙,患者极为痛苦,且无有效替代药物,极易引起医疗纠纷。本研究探讨改良Miccoli手术在全甲状腺切除中的安全性,从而有效保护甲状旁腺。方法回顾性分析2010-07-03-2015-07-19胜利油田中心医院乳腺甲状腺外科144例全甲状腺切除的甲状腺乳头状癌患者临床资料,根据治疗方法分成纳米碳组(A组)31例、改良Miccoli组(B组)71例和传统手术组(C组)42例,分析比较3组患者术后的甲状旁腺激素水平。结果A、B、C 3组患者术后第1天甲状旁腺激素水平分别为(7.85±2.45)、(5.39±2.15)和(4.50±1.83)pg/mL,3组之间差异均有统计学意义,F=23.123,P=0.001(A、B两组t=5.092,P<0.001;A、C两组t=6.697,P<0.001;B、C两组t=2.223,P=0.028);A、B、C 3组患者术后第7天甲状旁腺激素水平分别为(9.61±3.32)、(8.68±2.83)和(7.50±1.90)pg/mL;术后1个月甲状旁腺激素水平分别为(22.27±6.45)、(21.24±5.01)和(12.16±4.52)pg/mL。其中A、B两组术后7d(t=1.449,P=0.150)及术后1个月(t=0.793,P=0.432)甲状旁腺激素水平差异均无统计学意义,C组甲状腺旁腺激素水平明显低于A、B两组,与该两组相比术后7d及术后1个月甲状旁腺激素水平差异均有统计学意义,(术后第7天C、A两组t=0.197,P=0.003;C、B两组t=2.403,P=0.018;术后1个月C、A两组t=7.748,P<0.001,C、B两组t=9.654,P<0.001)。结论在全甲状腺切除时,改良Miccoli手术与纳米碳治疗效果相当,能安全有效的保护甲状旁腺,对于纳米碳显影不佳的部分患者,改良Miccoli手术可提供另外一种安全、有效的治疗方式。

OBJECTIVE The common complication of total thyroidectomy is hypoparathyroidism, and it can cause severe low calcium with great pain and there is no effective alternative drug for the treatment. This study aimed to explore the effectieness and feasibility for the improved Miecoli Surgery and protect parathyroid gland in total thyroidectomy. METHODS Retrospective study of the clinical date for 144 thyroidectomy patients were divided into three groups： nanocarbon group （A group）, improved Miccoli Group （B group） and traditional operation group （C group）. The levels of parathyroid gland hormone （PTH） from dif- ferent groups were collected for comparion and further analysis. RESULTS The PTH level in the first clay of the three groups （A,B,C）were （7.85±2.45）, （5.39±2.15） and （4.50±1.83） pg/mL,there were statistically significant differences among the three groups （A vs B,t=5. 092,P〈0. 001; A vs C,t=6. 697,P〈0. 001; B vs C,t=2. 223,P=0. 028; F=23. 123,P= 0.001）. The PTH level in the seventh day of the three groups （A,B,C） were （9. 61±3. 32）,（8. 68±2. 83）,（7. 50± 1.90） pg/mL,and that after one month were （22.27±6.45） ,（21.24±5.01） and （12.16±4.52） pg/mL. The PTH level for patients in group C was coherenly lower than that of group A and group B in the seventh day and the first month post-operatively, and that had significant differences （seventh day,C vs A,t=0. 197,P=0. 003,C vs B,t=2. 403,P=0. 018, one month,C vs A, t=7. 748,P〈0. 001 ,C vs B,t=9. 654,P〈0. 001）. The difference between group A and group B is statistically insignificant inthe seventh day and the first month post-operatively. CONCLUSIONS The improved Miccoli Surgery serves as a safe and effec- tires treatment in protecting parathyroid gland in total thyroidectomy, which is comparable to the nano carbon technique. It com- plements the nano carbon methods as a better alternative for patients with deficient nano carbon development.