监测血钙、血清及中央区引流液甲状旁腺激素对甲状腺切除术后评估甲状旁腺功能的临床意义

Clinical significance of monitoring blood calcium,serum parathyroid hormone and central drainage fluid parathyroid hormone in evaluating parathyroid function after thyroidectomy

目的分析甲状腺切除术后病人血清钙、甲状旁腺激素(parathyroid hormone,PTH)及中央区引流液PTH水平的变化特点,探讨监测上述指标对甲状腺术后评估甲状旁腺功能的临床意义。方法2018年1月~2021年1月就诊于我院普外科行甲状腺切除、中央区淋巴结清扫术病人112例,根据术中甲状旁腺原位保留0枚、1枚、2枚,分为A0、A1、A2组,测定病人术前及术后1~4天血钙、血PTH、中央区引流液PTH水平。结果112例病人发生低钙血症23例,其中A0组15例、A1组6例、A2组2例。各组血钙较术前均显著下降,A0组下降最明显,且在术后1~4天无明显升高趋势,而A1、A2组呈逐渐升高趋势,A2组升高更快;各组血PTH较术前均显著下降,A0组下降最明显,且在术后1~4天无明显升高趋势,A1、A2组血清PTH水平呈上升趋势,但术后4天内,上述两组血PTH均未上升至术前水平。各组引流液PTH水平差异显著,A2组均值最高,A1组次之,A0组最低;随着时间的推移,A0组无明显变化,A1、A2组病人引流液PTH水平总体呈下降趋势,A1组较A2组下降更快。结论甲状腺术后监测血钙、血PTH、引流液PTH可有效地评估原位保留甲状旁腺功能恢复情况,而中央区引流液PTH可直接反映原位保留甲状旁腺的活性,术后引流液维持在一个高水平是原位保留的甲状旁腺存活的直接证据。

Objective To explore the dynamic variation rule of serum calcium levels,serum parathyroid hormone levels and central drainage fluid parathyroid hormone levels after total thyroidectomy,To investigate the clinical significance of monitoring the above indexes in evaluating parathyroid function.Methods From January 2018 to January 2021,112 patients who received total thyroidectomy and bilateral central lymph node dissection in general Surgery Department of Qinghai provincial People's Hospital were chosen as the research objectve,According to the number of parathyroid glands(0,1,2)retained in situ,patients were divided into group A0,group A1 and group A2,Serum calcium,blood PTH and central drainage fluid PTH levels were detected before surgery and 1 to 4 days after surgery,Then we did a statistical analysis.Results There were 23 cases of hypocalcemia in 112 patients,including 15 cases in group A0,6 cases in group A1 and 2 cases in group A2.The level of postoperative serum calcium were lower than those before operative,And the most obvious decrease was group A0,There was no significant increase in postoperative 1~4 days,However,group A1 and A2 showed a trend of gradual increase,and group A2 showed a faster increase.The level of postoperative serum PTH were lower than those before operative,And the most obvious decrease was group A0,There was no significant increase in postoperative 1~4 days,The level of serum PTH in group A1 and group A2 showed an upward trend,But the level of serum PTH in the two groups did not increase to the preoperative level within 4 days after operation.The level of postoperative drainage fluid PTH was significantly different among all groups,With group A2 having the highest mean value,Group A1 followed by group A0 having the lowest.With the passage of time,there was no significant change in group A0,And the PTH level of drainage fluid in group A1 and group A2 showed a general downward trend,As well,The decrease of group 1 was faster than that of group A2.Conclusion By monitoring serum calcium,serum PTH and drainage fluid PTH,the functional recovery of orthotopic parathyroid gland can be effectively evaluated after thyroidectomy,The central drainage fluid PTH can directly reflect the activity of the in-situ retained parathyroid gland,The maintenance of a high level of postoperative drainage is direct evidence of orthotopic parathyroid survival.