不同术式对甲状腺癌患者甲状旁腺损伤的影响

Clinical Analysis of 17 Cases of Hypoparathyroidism Caused By Thyroid Carcinoma Surgery

【目的】探讨甲状腺癌手术术式对甲状旁腺损伤的影响及术中预防甲状旁腺损伤的方法。【方法】回顾性分析2010年9月至2011年9月收治的195例甲状腺癌患者的临床资料。【结果】腺叶切除＋峡部切除21例，术后无低钙血症发生；腺叶切除＋峡部切除＋同侧中央区清扫20例，术后暂时性低钙血症1例（5．00％，1／20）；腺叶切除＋峡部切除＋对侧次全切除＋同侧中央区清扫108例，术后暂时性低钙血症8例（7．41％，8／108）；甲状腺全切＋中央区清扫46例，术后暂时性低钙血症8例（17．39％，8／46）。低钙血症总发生率17例（8．72％，17／195），1例永久性甲状旁腺功能低下。误切甲状旁腺31例（15．90％，31／195），其中位于甲状腺腺体为12例，位于中央区为19例，仅1例（O．51％，1／195）表现为暂时性低钙血症。【结论】甲状腺癌手术术式的扩大增加了甲状旁腺损伤的可能，术后暂时性低钙血症发生率明显增加。术者熟悉掌握甲状旁腺解剖，保留甲状旁腺血供，是预防甲状旁腺损伤的有效方法。

[Objective]To explore the effect of surgical operation methods for thyroid carcinoma on para- thyroid injury and the method for preventing parathyroid injury. [Methods] Clinical data of 195 patients with thyroid carcinoma admitted to our hospital from Sept. 2010 to Sept. 2011 were analyzed retrospectively, iRe- suits] Of 21 patients undergoing lobectomy and isthmusectomy, no hypocalcemia occurred after operation. Of 20 patients undergoing lobectomy, isthmusectomy and ipsilateral central neck dissection, temporary hypocalce- mia occurred in one patient（ 5. 00 %, 1/20）. Of 108 patients undergoing lobectomy, isthmuseetomy, contraiat- eral subtotal and ipsilateral central neck dissection, temporary hypocalcemia occurred in 8 patients（7.41%, 8/ 108）. Of 46 patients undergoing total thyroideetomy and central neck dissection, temporary hypocalcemia oc- curred in 8 patients（17.39%, 8/46）. The total temporary hypocalcemia ratio was 8.72%（17 / 195）. One pa- tient with permanent hypoparathyroidism was found. Of 31 cases of parathyroid mis-resection（15.90~, 31/ 195）, 12 cases located in thyroid gland and 19 cases located in central neck. Only one patient showed tempora- ry hypocaleemia. [Conclusion] Surgical methods of thyroid carcinoma can increase the possibility of parathy- roid injury. The incidence of temporary hypocalcemia after operation is increased obviously. Understanding and handling the anatomy of parathyroid and retaining the blood supply of parathyroid by surgeon are effective method for avoiding parathyroid injury.