三种手术治疗甲状腺癌的手术学效果、甲状旁腺损伤比较

Comparison on Effects of Three Operations Treating Thyroid Cancer and Parathyroid Injury

目的探究甲状腺全切+颈淋巴结清扫术、甲状腺全切术和甲状腺次全切术三种手术治疗甲状腺癌的手术学效果和甲状旁腺损伤。方法收集2016年1月至2017年1月于我院行手术治疗的300例甲状腺癌患者临床病例,按照手术方式不同将其分为A组(甲状腺全切+颈淋巴结清扫术,n=82)、B组(甲状腺全切术,n=64)和C组(甲状腺次全切术,n=54)进行回顾性分析,比较三组患者手术前后甲状腺功能、PTH水平、血清钙水平和术后甲状旁腺损伤、低钙血症发生率。结果手术后,三组患者T3、T4、FT3、FT4水平均有显著降低,TSH水平显著上升,差异具有统计学意义(P<0.05);手术后,三组患者PTH和血清钙水平均有显著降低(P<0.05),C组PTH和血清钙水平显著低于A组和B组,差异具有统计学意义(P<0.05);C组甲状旁腺损伤率和低钙血症发生率显著低于A组和B组,差异具有统计学意义(P<0.05)。结论甲状腺全切+颈淋巴结清扫术、甲状腺全切术和甲状腺次全切术三种手术治疗甲状腺癌均能有效改善患者甲状腺功能,甲状腺次全切术对患者甲状旁腺损伤最轻,术后低钙血症发生风险最低,值得广泛推广。

Objective To discuss the effects of the total thyroidectomy plus radical neck dissection,total thyroidectomy and hypothyroidism in treating thyroid cancer and parathyroid injury.Methods 300 cases of thyroid cancer patients admitted and treated in our hospital during January 2016 and January 2017 were selected as the study objectives.According to the different operation methods,they were divided into group A（patients were given total thyroidectomy plus radical neck dissection,n=82）,group B（patients were given total thyroidectomy,n=64）and group C（hypothyroidism,n=54）.All patients were given retrospective analysis.Respectively compare the thyroid functions,PTH level,content of serum calcium,post-operative parathyroid injury and occurrence rate of hypocalcemia of before and of after operation.Results After operation,the T3,T4,FT3 and FT4 levels of all patients were all significantly decreased,while the TSH level was significantly increased.The difference showed a statistical significance（P〈0.05）.The comparison among the three groups showed no statistical significance（P〉 0.05）.After operation,the PTH and average content of serum calcium were all significantly decreased（P〈0.05）.The PTH and content of serum calcium in group C were significantly lower than group A and group B.The difference showed a statistical significance（P〈0.05）.The parathyroid injury rate and occurrence rate of hypocalcemia in group C were significantly lower than group A and group B.The difference showed a statistical significance（P〈0.05）.Conclusion The total thyroidectomy plus radical neck dissection,total thyroidectomy and hypothyroidism in treating thyroid cancer are proved to be effective in improving the patients＇ thyroid functions.Among the three operation methods,the total thyroidectomy causes the least parathyroid injury and the lowest risk of post-operative hypocalcemia.Thus,it deserves to be widely promoted.