摘要
目的探讨甲状腺下动脉不同结扎方式对甲状腺次全切除术后甲状旁腺功能影响。方法 2013年1月—2015年6月上海市第一人民医院宝山分院甲乳外科收治行甲状腺次全切除手术的患者86例,随机分为A组、B组各43例。A组术中行甲状腺下动脉分支结扎,B组术中行甲状腺下动脉主干结扎。比较2组手术治疗效果,手术前后血清甲状旁腺激素(PTH)、血钙水平变化以及术后并发症的发生情况。结果与B组比较,A组患者的手术时间、术后引流时间明显缩短,术中出血量、术后引流量明显减少(P<0.05);术后第1、5天,2组血清PTH较术前明显降低(P<0.05),A组仅术后1天血钙明显降低,术后第1、5天血清PTH、血钙水平均显著高于B组(p<0.05);A组低钙血症、症状性低钙血症及甲状旁腺功能减低的发生率较B组明显降低(34.9%vs.58.1%,23.3%vs.44.2%,14.0%vs.32.6%,P<0.05)。结论甲状腺次全切除术中保留甲状腺下动脉主干可有效保护甲状旁腺血供,减少术中出血和损伤,预防术后甲状旁腺功能减低。
Objective To explore the influence of different ways of ligation of inferior thyroid arteries on parathyroid function after subtotal thyroidectomy.Methods From January 2013 to June 2015,86 cases who received subtotal thyroidectomy in Department of thyroid and breast surgery in Shanghai First People＇s Hospital of Baoshan were randomly divided into Group A（n = 43） and Group B（n =43）.Group A and Group B were given branch ligation of inferior thyroid arteries and truncal ligation of inferior thyroid arteries respectively.The effect of operation,level of serum parathyroid hormone（PTH） and blood calcium before and after surgery,and post-operative complications between two groups were compared.Results Compared with Group B,the operation time,postoperative drainage time in Group A was significandy shortened,the intraoperative blood loss,postoperative flow was decreased significantly（P〈0.05）.Compared with before treatment,the level of serum PTH at 1,5 days after surgery was significantly decreased in both groups（P〈0.05）,while the blood calcium in Group A was obviously reduced only at 1 day after surgery.The serum PTH and blood calcium at 1,5 days after surgery in Group A were significandy higher than those in Group B（P〈0.05）.The incidence of hypocalcemia,symptomatic hypocalcemia and hypoparathyroidism（HPT） in Group A were significantly lower than those in group B（34.9%vs.58.1%,23.3%vs.44.2%,14.0%vs.32.6%,P〈0.05）.Conclusion Without ligation of the trunk of inferior thyroid arteries in subtotal thyroidectomy can effectively protect the blood supply of parathyroid,reduce intraoperative bleeding and damage and prevent from postoperative HPT.
出处
《疑难病杂志》
CAS
2016年第4期378-380,385,共4页
Chinese Journal of Difficult and Complicated Cases
