甲状腺癌不同术式对甲状旁腺功能的影响

Influence on Parathyroid Function Following Different Surgical Operations of Thyroid Neoplasms

目的探讨甲状腺癌不同术式对甲状旁腺功能的影响。方法回顾性分析2012年12月至2017年10月在内蒙古自治区人民医院行手术治疗的320例甲状腺癌患者的临床资料,依据手术方式不同将分为4组:甲状腺单侧腺叶及峡部切除+单侧中央区淋巴结清扫术(A组)、全甲状腺切除及单侧中央区淋巴结清扫术(B组)、全甲状腺切除及双侧中央区淋巴结清扫术(C组)、甲状腺癌改良或根治术(D组),每组80例。检测并比较各组患者术前、术后1 h、第1天、第3天及第7天的血清甲状旁腺激素(PTH)及血钙变化。结果各组患者术后1 h、1 d、3 d的PTH及血钙均呈下降趋势,各组术后第3天的PTH及血钙均达最低值,术后7 d均升高,PTH及血钙在术后各时点均为A组>B组>C组>D组。PTH及血钙在组内、时点间、组间·时点间交互作用比较差异均有统计学意义(P<0.01)。各组低PTH和低血钙(有症状和无症状)发生率比较差异均有统计学意义(P<0.05),其中BCD组低PTH和低血钙(有症状和无症状)均高于A组(P<0.05)。结论甲状腺癌不同手术方式均对甲状旁腺功能有影响,手术范围扩大会增加发生甲状旁腺功能减退及低钙血症的风险,术后可通过检测甲状旁腺素预测低钙血症的发生。

Objective To investigate the influence of different surgical operations of thyroid neoplasms on parathyroid gland function.Methods The clinical data of 320 patients with thyroid neoplasms who underwent thyroidectomy in Inner Mongolia People′s Hospital from Dec.2012 to Oct.2017 were retrospectively analyzed.The patients were divided into 4 groups according to different surgical methods,80 cases in each group(group A:unilateral thyroid lobe and isthmus resection plus unilateral central lymph node dissection;group B:total thyroidectomy and unilateral central lymph node dissection;group C:total thyroidectomy and bilateral central lymph node dissection;group D:modified or radical thyroidectomy).The serum concentrations of parathyroid hormone(PTH)and calcium preoperative and postoperative 1 h,1 d,3 d and 7 d in each group were detected,and the changes of serum PTH and serum calcium were compared.Results The levels of PTH and serum calcium in each group showed a decreasing trend 1 hour after operation and 1 day after operation.The PTH and serum calcium reached the lowest value on the third day after operation,and increased on the seventh day after operation.PTH and serum calcium at different time points were group A>group B>group C>group D.There were significant differences between groups,time points and group and time interaction(P<0.01).The incidences of low PTH and hypocalcemia(symptomatic and asymptomatic)in different groups were significantly different(P<0.05).The low PTH and hypocalcemia(symptomatic and asymptomatic)in group B,C,D were higher than those in group A(P<0.05).Conclusion Parathyroid function is affected by different surgical procedures of thyroid neoplasms.Expanding the scope of operation would increase the risk of hypothyroidism and hypocalcemia.Hypocalcemia could be predicted by detecting parathyroid hormone after surgical operation.