甲状腺全切联合颈淋巴结清扫术对甲状旁腺功能损伤的影响

Effect of total thyroidectomy combined with cervical lymph node dissection on parathyroid function injury

目的评价甲状腺全切联合颈淋巴结清扫术对甲状旁腺功能损伤的影响。方法回顾性分析2014年1月至2016年1月于陕西省第四人民医院普通外科接受手术治疗的300例甲状腺癌患者的临床资料,依手术方式不同分为全切组(n=100)与清扫组(n=200),全切组行甲状腺全切术,清扫组行甲状腺全切联合颈淋巴结清扫术,比较两组患者的甲状旁腺激素(PTH)、不同时间的血清钙水平、并发症发生情况及预后情况。结果术后3 d,清扫组患者的PTH水平为(18.51±3.03)pg/mL,明显低于全切组的(22.78±4.11)pg/mL,差异有统计学意义(P<0.05);术后1 h、1 d、3 d,两组患者的血钙水平比较差异均无统计学意义(P>0.05);清扫组患者暂时性声音嘶哑、暂时性低血钙发生率分别为32.00%、54.50%,明显高于全切组的18.00%、41.00%,差异均有统计学意义(P<0.05),而清扫组患者的永久性声音嘶哑、永久性低血钙发生率分别为3.50%、2.50%,与全切组的3.00%、1.00%比较差异均无统计学意义(P>0.05);清扫组患者3年无进展生存期为33.27个月,明显长于全切组的30.54个月,差异有统计学意义(P<0.05)。结论甲状腺全切联合颈淋巴结清扫术治疗甲状腺癌,虽能够延长患者无进展生存期,改善患者生存预后,安全性良好,但仍需注重术中对甲状旁腺功能的保护,术后避免低钙血症发生,临床可根据患者实际情况选择合适手术方案。

Objective To evaluate the effect of total thyroidectomy combined with cervical lymph node dissection on parathyroid function injury.Methods A retrospective analysis was performed on 300 patients with thyroid cancer who underwent surgery in Department of General Surgery,the Fourth People's Hospital of Shaanxi between January 2014 and January 2016,and the patients were divided into the total thyroidectomy group(n=100)and dissection group(n=200)according to different surgical methods.Total thyroidectomy group was given total thyroidectomy,and dissection group was given total thyroidectomy combined with cervical lymph node dissection.The thyroid function(parathyroid hormone[PTH]),serum calcium level at different times,occurrence of complications,and prognosis were compared between the two groups.Results At 3 d after operation,the level of PTH in the dissection group was(18.51±3.03)pg/mL,which was significantly lower than(22.78±4.11)pg/mL in total thyroidectomy group(P<0.05).At 1 h,1 d and 3 d after operation,there were no significant differences in the levels of serum calcium between dissection group and total thyroidectomy group(all P>0.05).The incidence rates of temporary hoarseness and temporary hypocalcemia in the dissection group were 32.00%and 54.50%,respectively,which were significantly higher than corresponding 18.00%and 41.00%in total thyroidectomy group(P<0.05),but there were no significant differences in the incidence rates of permanent hoarseness and permanent hypocalcemia between dissection group and total thyroidectomy group(3.5%vs 3.00%,2.50%vs 1.00%,P>0.05).The 3-year progression-free survival time in the dissection group was 33.27 months,which was significantly longer than 30.54 months in total thyroidectomy group(P<0.05).Conclusion Total thyroidectomy combined with cervical lymph node dissection for thyroid cancer can prolong the progression-free survival time and improve the survival prognosis of patients,and has good safety,but it is still necessary to pay attention to the protection of parathyroid function during operation and avoid the occurrence of hypocalcemia after operation,and the appropriate surgical regimens can be chosen according to the actual situation of patients in clinical practice.