全甲状腺切除术中紧密型甲状旁腺以极低损耗进行自体移植对比原位保留的临床实践体会

The clinical experience of autografting and in situ retention with very low loss of compact parathyroid gland during total thyroidectomy

目的:研究全甲状腺切除术中紧密型甲状旁腺以极低损耗进行自体移植(甲状旁腺组织匀浆注射法)对比原位保留对甲状腺癌患者术后甲状旁腺功能的影响。方法:回顾性分析因甲状腺癌接受甲状腺全切及中央区淋巴结清扫共93例患者的临床资料。将患者分为对照组(42例,甲状旁腺原位保留组,部分A2型旁腺,术中可见明确血管蒂且未离断者)与研究组(51例,甲状旁腺组织匀浆注射组,部分A2型旁腺及全部A3型旁腺,术中未见明确血管蒂或血管蒂已离断者)。比较两组患者术前及术后第1天、第3天、第7天、第30天血清Ca 2+及血清甲状旁腺激素(PTH)水平。结果:第1天,研究组患者血钙、血清PTH水平与对照组比较,差异均有统计学意义(P<0.05)。术后第3天,研究组患者血清PTH水平与对照组比较,差异均有统计学意义(P<0.05);两组血钙比较,差异无统计学意义(P>0.05)。术后第7天,研究组患者血钙、血清PTH水平与对照组比较,差异均无统计学意义(P>0.05)。术后第30天,研究组患者血清PTH水平与对照组比较,差异有统计学意义(P<0.05);两组血钙比较,差异无统计学意义(P>0.05)。结论:甲状旁腺组织即刻匀浆注射自体移植有助于减少甲状腺全切术后甲状旁腺功能低下的发生。

Objective To study the effects of parathyroid function after total thyroidectomy by immediate autotransplantation of compact parathyroid gland with very low loss(parathyroid tissue homogenate injection)and parathyroid gland preservation in situ in patients with thyroid cancer.Method The clinical data of 93 patients who received total thyroidectomy and central lymph node dissection for thyroid cancer were retrospectively analyzed.The patients were divided into 2 groups:control group(n=42,parathyroid gland in situ preservation group,part of A2 parathyroid glands,and those with definite vascular pedicle were observed during the operation),observation group(n=51,parathyroid tissue homogenization injection group,part of A2 parathyroid glands and all A3 parathyroid glands,and those with no definite vascular pedicle or severed vascular pedicle during the operation).The levels of serum calcium and parathyroid hormone(PTH)were compared in the 2 groups at day 1,3,7 and 30 before and after surgery.Results On the first day after operation,the levels of serum calcium and PTH in control group were different from those in observation group,the differences were statistically significant(P<0.05).On the third day after operation,there were no significant differences in serum calcium level between group A and group B(P>0.05),but the level of PTH made sense between two group(P<0.05).On the 7th day after operation,there were no significant differences in the levels of serum calcium and PTH between group A and group B(P>0.05).On the 30th day after operation,there were no significant differences in serum calcium level between group A and group B(P>0.05),but the level of PTH made sense between two groups(P<0.05).Conclusion Immediate homogenate injection of parathyroid tissue with autologous transplantation is helpful to reduce the hypoparathyroidism after total thyroidectomy.