不同入路途径根治术对甲状腺癌患者血钙水平及甲状旁腺功能的影响

Effect of different approaches in radical thyroidectomy on blood calcium and parathyroid function of patients with thyroid cancer

目的探讨不同入路途径根治术对甲状腺癌患者血钙水平及甲状旁腺功能的影响。方法将86例甲状腺癌患者按照随机数字表法分为研究组(n=43,行经口腔前庭入路根治术)与对照组(n=43,行经胸前入路根治术),比较两组患者甲状旁腺激素(PTH)水平、血钙水平、甲状旁腺指标及不良反应发生情况。结果术后第1、3天,两组患者血清中的PTH、血钙水平均明显降低,但研究组患者PTH、血钙水平均明显高于对照组,差异均有统计学意义(P﹤0.01)。研究组患者低PTH、低血钙、症状性低血钙发生率均低于对照组,差异均有统计学意义(P﹤0.05)。研究组患者不良反应总发生率为13.95%,与对照组的20.93%比较,差异无统计学意义(P﹥0.05)。结论经口腔前庭入路根治术可在一定程度上保护甲状腺癌患者的甲状旁腺功能,且对甲状腺癌患者PTH、血钙水平的影响低于经胸前入路根治术,但其不良反应发生情况与经胸前入路相似,因此需要医师结合患者的自身情况和手术条件选择较为合适且伤害较小的手术入路途径。

Objective To investigate the effect of different approaches in radical thyroidectomy on the blood calcium and parathyroid protection of patients with thyroid cancer.Method A total of 86 patients with thyroid cancer were randomly divided into the study group(n=43,treated with radical resection via oral vestibular approach)and control group(n=43,treated with radical resection via anterior thoracic approach).The parathyroid hormone(PTH),blood calcium,parathyroid indicators,and adverse reactions of two groups were compared.Result 1 and 3 days after surgery,the levels of blood PTH and calcium in two groups significantly decreased,but the levels of study group were significantly higher than those in the control group(P<0.01).The incidence of hypo-PTH,hypo-calcium and symptomatic hypo-calcium in the study group were lower than those in the control group(P<0.05).The total incidence of adverse reactions was 13.95% in the study group and 20.93% in the control group,with no statistically significant difference between the two groups(P>0.05).Conclusion Radical resection via oral vestibular approach can protect the parathyroid function of thyroid cancer patients,and its effect on PTH and blood calcium are lower than those via anterior thoracic approach,but the occurrence of adverse reactions is similar to the transthoracic approach.Therefore,it is necessary for physicians to select a more appropriate and less harmful surgical approach based on the patients’conditions and surgical conditions.