甲状腺术后引流液PTH监测的临床意义

Clinical significance of monitoring drainage fluid parathyroid hormone after thyroid surgery

目的分析甲状腺术后患者血钙、血清甲状旁腺激素（parathyroid hormone，PTH）及引流液PTH的变化特点，探讨甲状腺术后监测引流液PTH在判断甲状旁腺原位保留及功能中的临床意义。方法选择144例甲状腺疾病患者，将其按手术方式分为：单侧甲状腺腺叶切除组、单侧甲状腺腺叶切除＋单侧中央区淋巴结清扫组、甲状腺全切除术组、甲状腺全切＋单侧中央区淋巴结清扫组、甲状腺全切＋双侧中央区淋巴结清扫术组，并于术前及手术后第1~4天监测患者的血钙、血清PTH及引流液PTH，同时观察术后各组患者血钙下降、低钙血症及甲状旁腺功能减退的发生情况。对不同时间各组患者血钙、血清PTH及引流液PTH进行统计分析并评价其作为甲状腺术后甲状旁腺原位保留及功能判断指标的临床价值。结果114例中甲状腺术后血钙水平下降多发生在术后第2天（70例，61.40%），低钙血症者36例（31.58%），甲状旁腺功能减退34例（29.82%）。随着时间延长，各组患者血钙水平逐渐回升，且sPTH水平波动较大，但总体有升高趋势，且不同时间各组患者的血钙及sPTH水平呈正相关。监测dPTH发现各组患者间dPTH分布较为离散，且随时间变化而明显降低，在不同时间各组患者dPTH降低水平差异显著。结论甲状腺术后监测患者引流液PTH水平动态变化规律有助于判断原位保留甲状旁腺的存活及功能情况，对甲状腺术后行预防性补钙治疗有指导意义。

ObjectiveTo explore the clinical significance of monitoring drainage fluid parathyroid hor-mone （dPTH） for estimating the in situ reserves and function of the parathyroid by analyzing the change of serum calcium, serum parathyroid hormone （sPTH） and dPTH after thyroid surgery.MethodsAccording to the opera-tive method, the total of 144 patients with thyroid disease were divided into five groups： unilateral lobectomy, unilat-eral lobectomy plus isthmectomy with unilateral lymph node dissection, total thyroidectomy, total thyroidectomy with unilateral lymph node dissection, and total thyroidectomy with bilateral lymph node dissection group. The blood calcium, sPTH and dPTH level of patients were tested before operation and on the 1st, 2nd, 3rd and 4th day after operation. The depression of serum calcium, hypocalcemia and hypoparathyroidism were observed after opera-tion. The serum calcium, serum PTH and dPTH level were summarized and analyzed statistically in order to evalu-ate the in situ reserves and postoperative function of the parathyroid.ResultsAmong the 114 cases, the decline of serum calcium level mostly happened on the 2nd day after operation （70 cases, 61.4%） . There were 36 patients with hypocalcemia （31.58%） and 34 patients with hypoparathyroidism （29.82%） . Serum calcium level increased gradual-ly in all of the patients. Although sPTH level swung, it had a rising trend on the whole. The level of serum calcium and sPTH was positively correlated. The level of dPTH was discrete and decreased along with time. The decline lev-el of dPTH among different groups had statistical difference.ConclusionsIt is a promising method to evaluate the in situ reserves and function of the parathyroid by monitoring the level and changes of dPTH after thyroid surgery,and it is of value for preventive calcium supplementation after thyroid surgery.