手术方式对甲状腺乳头状癌术后甲状旁腺功能的影响

Impact of surgical modus on postoperative parathyroid function of patients with papillary thyroid carcinoma

目的探讨手术方式对甲状腺乳头状癌术后甲状旁腺功能的影响。方法甲状腺乳头状癌患者104例分为三组,分别行甲状腺(患侧腺叶+峡部)切除+同侧中央区淋巴结清扫(A组,26例)、甲状腺全切除+同侧中央区淋巴结清扫(B组,48例)和甲状腺全切除+双侧中央区淋巴结清扫(C组,30例)。检测术后第1天和术后1年血清甲状旁腺激素(PTH)和血钙水平,比较术后甲状旁腺功能低下发生率。结果术后第1天及术后1年,A组无甲状旁腺功能低下病例,B组甲状旁腺功能低下发生率为33.3%和4.2%,低于C组的50.0%和10.0%(P<0.05)。A组术后第1天血清PTH和血钙水平均高于B、C组(P<0.05)。A、B组术后1年血清PTH均高于C组(P<0.05)。结论甲状腺(患侧腺叶+峡部)切除+同侧中央区淋巴结清扫术式是甲状腺乳头状癌患者安全、有效的手术选择。

Objective To explore the impact of surgical modus on postoperative parathyroid function of patients with papillary thyroid carcinoma.Methods According to surgical modus,104 patients with papillary thyroid carcinoma were assigned into three groups of A（thyroidectomy of side lobus and isthmus＋ipsilateral lymph node dissection in centralregion,26cases）,B（total thyroidectomy＋ipsilateral lymph node dissection in central region,48cases）and C（total thyroidectomy＋bilateral lymph node dissection in central region,30cases）.Serum levels of parathyroid hormone（PTH）and blood calcium on the first day and in the first year after operation were detected and the incidence rate of low parathyroid function were compared among three groups.Results There was no case with low parathyroid function after surgery in group A.The incidence rates of low parathyroid function on the first day and in the first year after operation were 33.3% and 4.2% in group B,which were lower than 50.0% and 10.0%in group C（P〈0.05）.Serum levels of PTH and blood calcium on the first day after operation were higher in group A than those in groups of B and C（P〈0.05）.Serum level of PTH in the first year after operation was higher in groups of A and B than that in group C（P〈0.05）.Conclusion Surgical modus of thyroidectomy of side lobus and isthmus plus ipsilateral lymph node dissection in central region is safe and effective surgical option for the patients with papillary thyroid carcinoma.