术前各类型甲状旁腺分型在甲状腺癌开放性手术中的临床应用研究

Clinical Study of Preoperative Parathyroid Typing in Various Types of Thyroid Cancer in Open Surgery

目的研究术前各类型甲状旁腺分型在甲状腺癌开放性手术中临床的应用,从而降低患者在经甲状腺癌开放性手术后甲状腺功能衰退症(hypoparathyroidism,PHT)的发生率。方法随机抽取接受开放性甲状腺癌(thyroid carcinoma,TC)手术治疗的患者200例。按对甲状旁腺(parathyroid gland,PTG)术中保护方法的不同,分为改良组Ⅰ组(100例)和传统组Ⅱ组(100例)。Ⅰ组采用改良开放性手术,Ⅱ组采用传统手术方法。测定两组患者手术治疗后血浆白蛋白以及血清钙离子在血清中的浓度,统计并分析两组患者甲状旁腺功能衰退症的发生率。结果在术后的1~3天内,Ⅰ组神经-肌肉症发生率显著低于Ⅱ组患者,两组差异具有统计学意义(P <0. 05);Ⅰ组患者在手术后发生低钙血症的例数为16例,Ⅱ组患者在手术后发生低钙血症的例数为30例,两组具有统计学差异(P <0. 05);在对患者随访过程中发现,Ⅰ组患者的HTP发生率为16%,而Ⅱ组患者的HTP发生率高达30%,显著高于Ⅰ组患者,两组差异具有统计学意义(P <0. 05)。结论应用各类型甲状旁腺分型在甲状腺开放性手术中的甲状旁腺保护方案可显著降低术后甲状旁腺功能衰退症的发生率。

Objective To study the clinical application of various types of preoperative parathyroid type in the open operation of thyroid cancer,so as to reduce the incidence of hypoparathyroidism(PHT)after open surgery of thyroid cancer.Methods 100 patients with open thyroid carcinoma(TC)were randomly selected.According to the protection methods of parathyroid gland(PTG)during operation,they were divided into modified group groupⅠ(100 cases)and traditional group groupⅡ(100 cases).GroupⅠused modified open surgery and groupⅡused traditional surgical methods.The plasma concentrations of serum albumin and serum calcium were measured in the serum of the 2 groups after surgical treatment.The incidence of parathyroid gland function decreased in the 2 groups was statistically analyzed.Results Within 1 to 3 postoperative days,the incidence of neuro-muscular disease of groupⅠwas significantly lower than that in groupⅡ.There was statistically significant difference between the 2 groups(P<0.05);16 cases of hypocalcemia occurred after surgery in groupⅠ.The number of cases of hypocalcemia after operation in groupⅡwas 30 cases.There was a statistical difference between the 2 groups(P<0.05).The incidence of HTP in groupⅠwas 16%during the follow-up the incidence of HTP in GroupⅡwas as high as 30%,which was significantly higher than that of GroupⅠ.There was statistically significant difference between the 2 groups(P<0.05).Conclusion Application of various types of parathyroid parathyroid type of thyroid protection scheme in open surgery can significantly reduce the incidence of parathyroid function decline disease after surgery.