甲状腺癌手术发生甲状旁腺损伤的危险因素分析及处理策略

Risk Factors of Parathyroid Injury in Thyroid Cancer Surgery and the Strategies of Management

[目的]总结甲状腺癌手术中发生甲状旁腺损伤的危险因素和处理策略。[方法]回顾性分析405例甲状腺乳头状癌进行腺叶切除和中央区淋巴清扫时的手术方式、术后甲状旁腺素和血钙测定、临床有无甲状旁腺损伤表现等临床资料。[结果]405例甲状腺乳头状癌患者中,术后共出现甲状旁腺损伤症状28例,其中即刻血甲状旁腺激素(PTH)检查发现低于正常者22例,血钙低于正常者25例,通过静脉补钙,临床症状均消失;甲状旁腺损伤与年龄、性别、使用超声刀等因素无明显相关性(P>0.05),而与双侧腺叶全切和双侧Ⅵ区淋巴结清扫明显相关(P<0.05);在术中判断出现旁腺损伤并采用保护性措施(针刺除淤血、自体移植)后,术后发生甲状旁腺损伤症状与未发生损伤组相比无明显差异。[结论]甲状腺癌手术腺叶切除和中央区淋巴结清扫易发生甲状旁腺损伤,掌握正确的处理方法(腺体针刺清淤或旁腺移植)可以有效保护甲状旁腺。

[Objective] To analyze the risk factors of the parathyroid injury in thyroid cancer resection. [Methods] Clinical data of 405 cases with thyroid papillary carcinoma undergoing lobectomy and lymph node dissection were analyzed retrospectively, including surgical procedure, postoperative serum calcium and parathyroid hormone levels, clinical manifestations of parathyroid injury.[Results] Among 405 cases of papillary thyroid cancer surgery parathyroid injury occurred in 28 cases, in whom 22 cases had lower immediate parathyroid hormone（PTH）and 25 cases had lower serum calcium. After intravenous calcium supplement clinical symptoms disappeared in all patients. Parathyroid injury was significantly correlated with bilateral lobectomy and bilateral regionⅣ lymph node dissection（P〈0.05）, but was not correlated with age, gender, and application of ultrasound knife（P〉0.05）. In patients with parathyroid gland injury, after management with protective measures there was no significant difference in the incidence of symptoms of postoperative parathyroid injury compared with the non-injury patients. [Conclusion] Bilateral thyroid lobectomy and region Ⅵ lymph node dissection are the risk factors of intraoperative parathyroid injury,and the appropriate management is acquired to achieve effective protection for the parathyroid.