甲状腺全切除术对甲状腺乳头状癌伴桥本甲状腺炎患者术后PTH的影响

Effect of total thyroidectomy on PTH after surgery for papillary thyroid carcinoma with Hashimoto's thyroiditis

目的探讨甲状腺全除切术对甲状腺乳头状癌伴桥本甲状腺炎患者术后甲状旁腺激素(PTH)的影响。方法选取467例甲状腺乳头状癌患者,其中单纯甲状腺乳头状癌患者332例(对照组),甲状腺乳头状癌伴桥本甲状腺炎患者135例(观察组)。对两组患者进行手术治疗,观察并比较两组患者术后PTH和血钙水平。结果术后7天,观察组患者的PTH和血钙水平分别为(1.28±0.32)pmol/L和(2.21±0.32)mmol/L,分别低于对照组的(2.57±0.44)pmol/L和(2.48±0.40)mmol/L,差异均有统计学意义(P﹤0.05);术后观察组患者甲状旁腺功能减退、低血钙和水肿的发生率分别为60.74%、46.67%和31.85%,高于对照组的28.01%、18.07%和18.98%,差异均有统计学意义(P﹤0.05)。观察组患者的术后引流量为(78.20±14.29)ml,高于对照组的(32.02±10.03)ml,差异有统计学意义(P﹤0.05)。观察组中行甲状腺全切除术的患者术后甲状旁腺功能减退和低血钙的发生率均为15.56%,均低于行甲状腺全切除术+中央区淋巴结清扫和甲状腺全切除术+中央区及侧颈淋巴结清扫的患者(P﹤0.05)。结论与单纯甲状腺乳头状癌患者相比,伴桥本甲状腺炎的甲状腺乳头状癌患者行甲状腺全切除术后发生甲状旁腺功能减退和低血钙的比例高,且手术方式对术后甲状旁腺功能减退和低血钙的发生有影响。

Objective To investigate the effect of total thyroidectomy on parathyroid hormone（PTH） in papillary thyroid carcinoma with Hashimoto’s thyroiditis. Method 467 cases of papillary thyroid carcinoma were treated in the hospital, including 332 cases of simple papillary thyroid carcinoma（control group） and 135 cases of papillary thyroid carcinoma combined with Hashimoto’s thyroiditis（study group）. PTH and blood calcium levels in two groups after surgery were observed and compared. Result In the study group, PTH and blood calcium in 7 d after surgery were（1.28 ±0.32） pmol/L and（2.21 ± 0.32） mmol/L, respectively, which were significantly lower than those of the control group at（2.57±0.44） pmol/L and（2.48±0.40） mmol/L, with statistically significant difference observed（P〈0.05）; the incidence of hypoparathyroidism, hypocalcemia and postoperative edema in study group was 60.74%, 46.67% and 31.85%, respectively, which were significantly higher than those in the control group at 28.01%, 18.07% and 18.98%, demonstrating significant differences（P〈0.05）. The drainage volume after surgery was（78.20±14.29） ml in study group, which was more than that of the control group at（32.02±10.03） ml, the difference was statistically significant（P〈0.05）. The incidence of postoperative hypoparathyroidism and hypocalcemia in study group that had total thyroidectomy was 15.56%, and was significantly lower than in those with total thyroidectomy ＋ central lymph node dissection and those with total thyroidectomy ＋central and lateral cervical lymph node dissection patients（P〈0.05）. Conclusion Compare to patients with simple papillary thyroid carcinoma, those who were combined with Hashimoto’s thyroiditis have high incidence of hypoparathyroidism and hypocalcemia after total thyroidectomy, and operative modality has an impact on the occurrence of postoperative hypoparathyroidism and hypocalcemia.