分化型甲状腺癌术中甲状旁腺原位显露与保护研究

Parathyroid in situ exposure and protection in differentiated thyroid carcinoma surgery

目的研究分析原位显露与保护甲状旁腺在分化型甲状腺癌术中应用价值。方法选取宁波市第七医院2012年1月至2014年12月收治的分化型甲状腺癌患者500例，根据手术过程中是否将甲状旁腺解剖显露将所有患者平分为显露组和未显露组，然后根据肿物范围及危险因素，将显露组再次分为E1组（行患侧腺叶、峡叶切除、单侧Ⅵ区淋巴结清扫）、E2组（行全切或次全切甲状腺切除、双侧Ⅵ区淋巴结清扫），将未显露组分为C1组（术式同E1组）、C2组（术式同E2组）。术后观察患者神经、肌肉症状如面部、口唇、手足麻木感及抽搐等临床表现，于术前、术后1、3、5、7、14及28d检测甲状旁腺激素（parathyroidhormone，P11H）和血钙指标水平。结果显露组和未显露组淋巴结转移率及清扫数目差异无统计学意义（r=1．02、0．79，P=0．14、0．96）。2组随访期间复发率表示差异无统计学意义（x^2=0．23，P=0．65）。E1组术后甲状旁腺功能下降、低钙血症发生率、甲状旁腺误切率明显低于C1组，E2组术后甲状旁腺功能下降、低钙血症发生率、甲状旁腺误切率明显低于C2组，比较差异有统计学意义（P〈0．05）。结论术中采用放大镜辅助直视下显露、原位保护甲状旁腺，降低误切及暂时性甲状旁腺功能减退发生率，能有效避免甲状腺全切术后引发的不良后果．经本研究证明效果显著，适合临床广泛应用。

Objective To study the application value of parathyrod in situ exposure and protection in differentiated thyroid cancer thyroid carcinoma （DTC） surgery. Methods 500 cases of DTC admitted from Jan. 2012 to Dec. 2014 were selected for the research. According to whether the parathyroid was anatomically exposed during the surgery, the patients were divided into experimental group （exposed group） and the control group （unexposed group）. Then, depending on tumor extent and risk factors, the experimental group were divided into group E1 （lateral affected glandular lobe, isthmus lobe resection and unilateral VI lymph node dissection）and E2 （total or subtotal thyroidectomy and bilateral VI lymph node dissection）, while the control group were divided into group C1 （surgical treatment same as E1 ）and group C2 （surgical treatment same as E2）. Patients＇ postopera- tive nerve and muscle symptoms were observed, such as clinical manifestations of face, lips, hand and foot numb- ness or convulsions. Both preoperatively and postoperatively, patients＇ parathyroid hormone （PTH） and serum calcium level indicators were detected before surgery and at the 1st, 3rd, 5th, 7th, 14th and 28th day after surgery. Results The lymph node metastasis rate and number between experimental group and the control group had statistical insignificance 0（2=1.02, 0.79, P=0.14, 0.96）. The recurrence rate of the 2 groups had no significant difference during the follow-up （~=0.23, P=0.65 ）. Group E1 was significantly lower than Group C1 in postoperative parathyroid function decline rate, incidence of hypocalcemia and parathyroid mistakenly cut rate. Group E2 was also obviously lower than Group C2 in all these aspects. The difference had statistical significance （P〈0.05）. Conclusion Parathyrod in situ exposure and protection assisted by direct vision of the magnifying glass can reduce the mistakenly cut rate of parathyroid and the temporary hypoparathyroidism, which can effectively avoid the adverse effects caused by total thyroideetomy.