显微镜下双极电凝辅助甲状旁腺原位保留的临床研究

Research on microscope and bipolar coagulation on parathyroid gland protecting during total thyroidectomy

目的探讨甲状腺全切手术中,显微镜辅助下使用双极电凝镊精细解剖并原位保留甲状旁腺的临床价值。方法选择2014年6月~2016年6月我院甲状腺全切手术患者120例,随机分为对照组与观察组各60例,观察组采用显微镜辅助双极电凝镊精细解剖原位保护甲状旁腺,对照组采用超声刀实施手术。对比两组术后1 d的血清钙及PTH变化,统计两组3个月内低血钙及低PTH发生率,比较两组暂时性及永久性甲状旁腺功能减退的发生率。结果两组术后1 d血清钙(t=4.01、6.05,P<0.05)及PTH(t=3.97、4.35,P<0.05)均较术前显著降低,但两组间无明显差异(t=0.84、0.68,P>0.05)。观察组术后3个月的低血钙发生率(χ~2=6.261,P<0.05)、低PTH发生率(χ~2=5.167,P<0.05)以及暂时性甲状旁腺功能减退发生率(χ~2=6.817,P<0.05)均显著低于对照组。两组术后均无永久性甲状旁腺功能减退。结论显微镜辅助下使用双极电凝精细解剖,有助于原位保护甲状旁腺功能,减少术后暂时性甲状旁腺功能减退发生率。

Objective To analyze the clinical value of microscope and bipolar coagulation on protecting parathyroid gland during total thyroidectomy. Methods A total of 120 cases of patients performed total thyroidectomy were divided into two groups randomly from June 2014 to June 2016 in our hospital. Observation group was treated with microscope and bipolar coagulation when dissecting parathyroid gland. Control group was treated with harmonic scalpel in routine methods. Serum calcium and PTH of two group cases 1 day after operation were analyzed. The incidences of hypoeal- cemia, low PTH, and transient or permanent hypoparathyroidism cases within 3 months were observed. Results The serum calcium （t=4.01, 6.05,P〈0.05） and PTH （t=3.97, 4.35, P〈0.05） of both groups were decreased, but there was no statistical difference between two groups（t=0.84, 0.68, P〉0.05）. The incidences of hypoealeemia （χ2=6.261, P〈0.05）, loW PTH （χ2=5.167, P〈0.05）, and transient hypoparathyroidism（χ2=6.817, P〈0.05） of observation group were lower than control group. No permanent hypoparathyroidism occured in two groups. Conclusion Microscope and bipolar coagula- tion can help to protect parathyroid gland in total thyroidectomy, and reduce the incidence of the transient hypoparathy- roidism.