甲状腺癌根治术联合甲状旁腺自体移植术治疗甲状腺癌的效果观察

Effects of radical resection of thyroid carcinoma combined with parathyroid autotransplantation on thyroid carcinoma

目的 探讨甲状腺癌根治术联合甲状旁腺自体移植(PAT)治疗甲状腺癌对患者术后甲状旁腺激素、血钙和术后并发症的影响。方法 回顾性分析2016年11月至2018年11月南阳医学高等专科学校第一附属医院行全腔镜下甲状腺根治术的86例患者(对照组)和行全腔镜下甲状腺根治术+PAT术的114例患者(观察组)的临床资料,观察两组术后1 d、3 d、7 d的临床症状、体征,比较两组术后1 d、1周、4周、12周、24周的甲状旁腺激素(PTH)水平和血钙含量,评估两组术后并发症发生情况。结果 术后1 d、3 d、7 d,观察组同时间点的感觉异常、指/肢端麻木、腕-足痉挛、面神经征、陶瑟征及焦虑的发生率低于对照组(P<0.05);两组患者术后4周、12周、24周的PTH水平和血钙含量高于术后1 d(P<0.05),观察组术后4周、12周、24周上述指标高于对照组(P<0.05),两组组间效应、时间点效应和组间与时间点交互效应比较,差异有统计学意义(P<0.05);观察组术后低血钙症、暂时性甲状旁腺功能低下(HP)和永久性HP的发生率分别为0.05%、13.16%和0,低于对照组(0.13%、36.05%和8.14%,P<0.05)。结论 甲状腺癌根治术联合PAT术治疗甲状腺癌能改善术后临床症状、体征,改善术后PTH水平和血钙含量低下,降低术后暂时性HP和永久性HP发生风险。

Objective To investigate the effects of radical resection of thyroid carcinoma combined with parathyroid autotransplantation(PAT)on postoperative parathyroid hormone,serum calcium and postoperative complications in thyroid carcinoma.Methods A retrospective analysis was performed on data of 86 cases undergoing total laparoscopic radical resection of thyroid carcinoma(control group)and 114 cases undergoing total laparoscopic radical resection of thyroid carcinoma and PAT(observation group)from November 2016 to November 2018.The clinical symptoms and signs were observed in the two groups on 1 d,3 d,7 d after operation.The levels of parathyroid hormone(PTH)and serum calcium were compared between the two groups on 1 d,1 w,4 w,12 w,24 w after operation.The occurrence of postoperative complications was evaluated in the two groups.Results On 1 d,3 d,7 d after operation,the incidences of sensory abnormality,finger/limb numbness,wrist-foot spasm,facial sign,Trousseau sign and anxiety in observation group were lower than those in control group(P<0.05).The levels of PTH and serum calcium in the two groups at 4 w,12 w and 24 w after operation were significantly higher than those at 1 d after operation(P<0.05),and the above indexes in observation group at 4 w,12 w,24 w after operation were significantly higher than those in control group(P<0.05),and there were statistically significant differences in the between-group effects,time-point effects and interaction effects of between-group and time-point in the two groups(P<0.05).The incidences of postoperative hypocalcemia,temporary hypoparathyroidism(HP)and permanent HP were 0.05%,13.16%and 0 respectively in observation group,which were significantly lower than 0.13%,36.05%and 8.14%in control group(P<0.05).Conclusions Radical resection of thyroid carcinoma combined with PAT for thyroid carcinoma can significantly improve postoperative clinical symptoms and signs,significantly improve postoperative PTH level and low serum calcium,and reduce the risk of postoperative temporary HP and permanent HP.