甲状腺全切术对患者血清PTH的影响

目的观察甲状腺全切术对于患者血清甲状旁腺素（PTH）等相关指标的影响。方法2015年1月至2016年12月间采取甲状腺全切术治疗的104例患者作为观察对象，根据手术范围将全部患者划分为单纯组与联合组，单纯组患者手术切除范围为单纯甲状腺切除，联合组，为甲状腺全切联合颈淋巴结清扫术。多点监测两组患者PTHT及血清钙水平，检测两组患者术前及术后3d时的三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）水平并进行比较术后5d统计两组低钙血症及甲状旁腺功能减退发生率，分析其与PTH水平的相关性。结果单纯组患者PTHAk．术前至术后5d多点监测整体优于联合组（P〈0．01）；单纯组患者血钙水平从术前至术后5d多点监测整体优于联合组（P〈0．05）。治疗前两组T3、T4、TSH差异均无统计学意义（P〉0．05）；治疗后两组T3、T4均明显下降、TSH均明显上升，组内比较差异有统计学意义（P〈0．01）；治疗后单纯组T3低于联合组（P〈0．05），T4、TSH组间比较差异无统计学意义（P〉0．05）。单纯组低钙血症发生率为42．22％、甲状旁腺功能减退发生率为46．67％，联合组低钙血症发生率为62．71％、甲状旁腺功能减退发生率为66．10％；单纯组均低于联合组（P〈．05）。低钙血症发生与PTH水平间具有高度正相关性（O．8〈r〈1，P〈0．01）。结论甲状腺全切术对于患者的甲状腺功能可造成一定程度的影响，手术范围的加大，可导致甲状腺功能、甲状旁腺功能受到更大的影响，因此术中应尽量减小手术范围，最大限度的保护甲状旁腺功能；对于PTH的监测可为术后低钙血症的预测提供重要参考。

Objective To observe the effect of total thyroidectomy on the serum PTH and other related indexes. Methods 104 Cases underwent total thyroideetomy were selected as the observation object in our hospital from January 2015 to December 2016, according to the scope of operation they were divided into simple group and combination group, simple group of patients with surgical resection alone thyroidectomy, combination group thyroid gland resection combined with neck dissection. The two groups of patients with parathyroid hormone （ PTH ） and serum calcium levels, three triiodothyronine detection of two groups of patients before and after operation of 3d （ T3 ） , thyroxine （ T4 ） , thyroid stimulating hormone （ TSH ） level were monitored with multi-point and the incidence of hypothyroidism was compared. The two groups of hypocaleemia and parathyroid gland function were counted 5 days after surgery, and its correlation with the level of PTH was analyzed. Results In the simple group, the multi- point monitoring of PTH from preoperative to postoperative 5d was better than that of combined group, P〈0.01. The level of serum calcium in the simple group was better than that of the combined group （ P〈0.05 ） , from preoperative to postoperative 5d monitored. Before treatment, two groups of T3, T4 and TSH were no significant difference between the two groups after treatment （P〉0.05） . After treatment, two groups of T3 and T4 were decreased, TSH were significantly increased in group, the difference was statistically significant, T3 was lower than that of pure in the combination group （ P〈0.05 ） , T4 and TSH was not statistically significant between the two groups （ P〉0.05 ） . Simple group of hypoealcemia incidence was 42.22%, hypothyroidism incidence rate was 46.67%, the incidence rate was 62.71% in combined group of hypocaleemia and hypoparathyroidism occurred in 66.10%. The simple group was lower than the combined group （ P〈0.05 ） . With a high degree of positive correlation between incidence of hypocaleemia with PTH levels of 0.8〈r〈1, P〈0.01. Conclusion Total thyroidectomy will cause a certain degree of influence on thyroid function of patients, the increase of the scope of operation can have greater influence on thyroid function and parathyroid function, so we should minimize the scope of operation to protect parathyroid function. PTH monitoring can provide an important reference for the prediction of postoperative hypocalcemia.