甲状腺癌不同手术方式对甲状旁腺功能的影响

Influence of Different Surgical Treatments of Thyroid Cancer on the Function of Parathyroid

目的探讨甲状腺癌不同手术方式对甲状旁腺激素(parathyroid hormone,PTH)、血钙的影响,总结预防甲状旁腺功能减退发生的方法。方法回顾性分析作者医院2013-01/2014-12月期间234例甲状腺癌患者手术治疗的手术方式,观察甲状旁腺功能减退的发生率和术前术后PTH及血钙变化情况。结果术后甲状旁腺功能减退的总发生率29%,各种术式甲状旁腺功能减退的发生率依次为甲状腺全切除术+患侧颈淋巴结廓清术,甲状腺全切除术+双侧中央区淋巴结清扫,甲状腺全切除术+患侧中央区淋巴结清扫,甲状腺全切除术,单侧腺叶切除术+对侧腺叶近全切除术+患侧中央区淋巴结清扫;术后1 d PTH及血清钙水平较术前均有明显下降(P<0.05,P<0.01)。结论甲状腺癌不同手术方式和手术范围对甲状旁腺功能均有不同程度的影响,手术范围越大,术后发生甲状旁腺功能减退及低钙血症的可能性及程度就越大。预防甲状腺术后甲状旁腺功能减退的关键在于保护甲状旁腺及其血管。

Objective To discuss the influence of different surgical treatment of thyroid cancer on parathyroid hor- mone （PTH） and serum calcemia, and conclude prevention measures about hypoparathyroidism. Methods A total of 234 thyroid cancer patients with different operative types of thyroid cancer in authors＇ hospital from January 2013 to December 2014 were retrospectively reviewed. The incidences of hypoparathyroidism, preoperative and postoperative PTH and serum calcium changes were observed. Results The overall rate of hypoparathyroidism was 29%. Hypoparathyroidism rates of each operative types were compared： total thyroidectomy＋ neck lymph node extended dissection〉total thyroidectomy ＋ bilateral central lymph node dissection〉total thyroidectomy ＋ ipsilateral central lymph node dissection^total thyroidec- tomy〉unilateral lobectomy ＋ side lobe near-total thyroidectomy ＋ ipsilateral central lymph node dissection. Postoperative 1 day, PTH and serum calcium levels were significantly decreased than those before the operation. Conclusion Postopera- tive parathyroid functions are variously associated with thyroid cancer surgeries and operative extent. The greater the scope of operation, the more possibilities and degrees of postoperative hypoparathyroidism and hypocalcemia. The protection of parathyroid glands and its artery are important for postoperative hypoparathyriodism prevention.