甲状腺不同手术方式对甲状旁腺功能的影响

Influence of different surgical approaches to parathroid function

目的:探讨甲状腺不同手术方式术后甲状旁腺素(PTH)、血钙的变化,总结预防甲状腺术后甲状旁腺功能减退发生的方法及并发症的处理。方法:检测2012年1—5月191例甲状腺手术患者术前及术后血清PTH、血钙,比较术前、术后的变化,并按照手术范围分7组,比较各组之间术后PTH、血钙的变化。结果:各组术后较术前比较,血钙、血PTH均明显下降(P<0.05)。同组术后1 d与4 d血PTH、血钙之间比较,差异无统计学意义(P>0.05)。各组低血PTH、症状性低钙血症的发生率以及术后PTH下降幅度的比较:全甲状腺切除+双侧颈中央区淋巴清除组、全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除组>甲状腺双叶切除组>甲状腺单叶切除组,其差异有统计学意义(P<0.05﹚,而在全甲状腺切除,以及同样范围的颈中央区淋巴清除的基础上,是否行改良颈清,对于术后低PTH血症及症状性低钙血症的发生率以及PTH下降的幅度,差异无统计学意义(P>0.05﹚。低血钙的发生率比较:甲状腺单侧腺叶切除与其他6种手术方式比较、甲状腺双侧腺叶切除与全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除比较,差异有统计学意义(P<0.05﹚。结论:各种甲状腺术式对甲状旁腺功能均有不同程度的影响,手术范围越大,术后并发甲状旁腺功能减退的可能性越大。预防术后甲状旁腺功能减退的根本,就在于术中甲状旁腺的保护。

Objictive： Hypothyroidism is the common complication after thyroidectomy. The study was to investigate the changes of serum concentration of parathyroid hormone（PTH） and calcium after different thyroid surgical approaches and summarize the methods of preventing the hypoparathyroidism or treating complications. Metheods： This study included 191 patients who under went thyroid surgeries between January 2012 to May 2012. The serum level of Parathyroid hormone （PTH） and calcium was measured and compared before and after the surgery. According to the extent of the surgery, Patients were classified into seven groups and the postoperative changes of PTH and serum calcium were compared between different groups. Then statistical analysis was performed. Results： In each group, postoperative serum level of Parathyroid hormone （PTH） and calcium was significantly decreased than the preoperative（P〈0.05）. The results about comparison of low serum PTH, the incidence of symptomatic hypocalcemia, and the magnitude of postoperative PTH decline in all groups are as follows： ＂total thyroidectomy（TT） with bilateral central compartment lymph node dissection（CLND）, TT with unilateral CLND plus contralateral modified neck dissection＂ group〉＂TT＂ group〉＂hemithyroidectomy＂ group. The differences were statistically significant （P〈0.05）. But there is no statistical difference（P〉0.05）, on the incidence of postoperative low PTH hyperlipidemia,the symptomatic hypocalcemia and the amplitude of PTH decline whether underwent modified neck dissection after total thyroidectomy or based on the same range of central neck dissection. About the incidence of hypocalcemia, there are significant differences on both comparison of the hemithyroidectomy with the other six surgical approaches and comparison of TT comparison with TT with unilateral CLND plus contralateral modified neck dissection. Conclusion： All kinds of thyroid surgeries affect the parathyroid function in varying degrees. The greater the extent of surgery is, the higher the possiblility of postoperative hypoparathyroidism is. The key to the prevention of postoperative hypoparathyroidism is the protection of parathyroid intraoperativily.