甲状腺癌根治术联合甲状旁腺自体移植的临床观察

Clinical observation of total thyroidectomy combined with autotransplantation of parathyroid gland

目的探讨甲状腺癌根治术联合甲状旁腺自体移植的临床效果。方法选取2019年1月至2021年9月在宜昌市中心人民医院甲乳外科收治的经病理诊断为甲状腺乳头状癌,选择首次行甲状腺全切及中央区淋巴结清扫术的76例患者为研究对象,随机分成两组,对照组38例(未行甲状旁腺自体移植),试验组38例(采取甲状旁腺自体移植)。术后比较两组临床疗效(显效、有效、无效),术后甲状旁腺素(1 d、1周、1个月、6个月)及术后暂时性及永久性甲状旁腺功能减退发生率。结果试验组的总有效率为97.37%,高于对照组的78.95%,差异有统计学意义(P<0.05);两组甲状旁腺素术后1 d、1周、1个月比较,差异无统计学意义(P>0.05),甲状旁腺素术后6个月比较,差异有统计学意义(P<0.05);试验组暂时性甲状旁腺功能减退发生率为44.74%,低于对照组的52.63%,差异无统计学意义(P>0.05),而试验组永久性甲状旁腺功能减退发生率水平为0,明显低于对照组的5.26%,差异有统计学意义(P<0.05)。结论在甲状腺癌根治术中,行甲状旁腺自体移植相比未行甲状旁腺自体移植,对于永久性甲状旁腺功能损伤具有良好的治疗效果,能够有效地降低甲状旁腺损伤,应广泛运用于甲状腺外科治疗中。

Objective To investigate the clinical effect of radical thyroidectomy combined with parathyroid autotransplantation.Methods From January 2019 to September 2021,76 patients with thyroid papillary carcinoma diagnosed pathologically in the Department of thyroid and breast surgery of Yichang Central People’s Hospital were selected as the research objects.They were randomly divided into two groups,38 in the control group(without parathyroid autotransplantation)and 38 in the test group(with parathyroid autotransplantation).The clinical efficacy(markedly effective,effective and ineffective),postoperative parathyroid hormone 1 day,1 week,1 month and 6 months and the incidence of postoperative temporary and permanent hypoparathyroidism were compared between the above two groups.Results The total effective rate of the experimental group 97.37%was higher than that of the control group 78.95%,with statistically significant difference(P<0.05);Comparison of parathyroid hormone between two groups at 1 day,1 week and 1 month after operation,there was no significant difference(P>0.05),compared with parathyroid hormone 6 months after operation,with statistically significant difference(P<0.05);The incidence of temporary hypoparathyroidism in the experimental group was 44.74%lower than 52.63%in the control group,there was no significant difference(P>0.05),while the incidence of permanent hypoparathyroidism in the experimental group was 0 lower than 5.26%in the control group,with statistically significant difference(P<0.05).Conclusion In radical thyroidectomy,parathyroid autotransplantation has a good therapeutic effect on permanent parathyroid function injury compared with no parathyroid autotransplantation,and can effectively reduce parathyroid injury.It should be widely used in thyroid surgery.