摘要
背景与目的:手术是治疗甲状腺疾病的一种极为重要的方式,而甲状旁腺功能减退是甲状腺手术的常见并发症之一。由于各类甲状腺疾病采取的手术方式不同,对甲状旁腺功能的影响也可能不同。本研究探讨甲状腺不同术式对甲状旁腺功能影响的差异并分析原因。方法:回顾性分析2017年8月-2019年3月收治的319例甲状腺手术患者的临床资料,其中,行甲状腺单侧腺叶切除111例(单侧切除组)、行甲状腺双侧腺叶切除107例(双侧切除组)、行甲状腺双侧腺叶切除+中央区淋巴清扫术71例(双侧切除+Ⅵ区清扫组)、行甲状腺双侧腺叶切除+中央区淋巴清扫术+侧颈区淋巴清扫术30例(双侧切除+Ⅱ~Ⅵ区清扫组)。术中在患侧近峡部周围被膜选择1~2点,每点注射0.1~0.2 mL纳米炭混悬注射液,所有患者均采取精细被膜解剖法原位保留甲状旁腺,若术中发现甲状旁腺无法原位保留则立即将该甲状旁腺剪成薄片或匀浆移植包埋于胸锁乳突肌中。观察并比较各组手术前后甲状旁腺激素(PTH)与血钙水平的变化以及术后甲状旁腺功能减退与低钙血症发生率。结果:各组术前一般资料及PTH与血钙水平均无统计学差异(均P>0.05)。各组术后PTH和血钙浓度均较术前明显降低(均P<0.01),但两者的下降幅度在术后相同时间点随着手术范围扩大而明显增大,即单侧切除组<双侧切除组<双侧切除+Ⅵ区清扫组<双侧切除+Ⅱ~Ⅵ区清扫组,差异均有统计学意义(均P<0.05)。甲状旁腺功能减退与低钙血症的发生率同样随着手术范围扩大而升高,单侧切除组、双侧切除组、双侧切除+Ⅵ区清扫组、双侧切除+Ⅱ~Ⅵ区清扫组甲状旁腺功能减退发生率分别为9.9%、32.7%、56.3%、73.3%,低钙血症发生率分别为0、1.9%、19.7%、50.0%,组间差异均有统计学意义(均P<0.05)。所有患者随访至24周,无永久性甲状旁腺功能减退发生。结论:各种甲状腺手�
Background and Aims:Surgery plays an important role in the treatment of thyroid disease,and hypoparathyroidism is one of the common complications of thyroid surgery.However,different kinds of thyroid pathologies have different indications for different types of thyroid surgery,which may exert different impacts on parathyroid function.This study was conducted to investigate the differential influences of different types of thyroid surgery on parathyroid function and analyze the reasons.Methods:The clinical data of 319 eligible patients who underwent thyroid surgeries from April 2017 to March 2019 were retrospectively analyzed.Of the patients,111 cases underwent unilateral thyroid lobectomy (unilateral resection group),107 cases underwent bilateral thyroid lobectomy (bilateral resection group),71 cases underwent bilateral thyroid lobectomy with central lymph node dissection (bilateral resection plus level Ⅵ dissection group),and 30 cases underwent bilateral thyroid lobectomy with central and lateral neck dissection (bilateral resection plus level Ⅱ–Ⅵ dissection group).During the operation,1-2 points on the capsule around the affected side close to the isthmic region were selected,and 0.1-0.2 mL of nanocarbon suspension was injected at each point.Meticulous capsular dissection technique was adopted in all patients for in-situ preservation of the parathyroid glands.If the parathyroid glands failed to be retained in situ,they were immediately cut into pieces or homogenates and reimplanted into the sternocleidomastoid muscle.The changes in parathyroid hormone (PTH) and blood calcium levels before and after surgery as well as the incidence rates of postoperative hypoparathyroidism and hypocalcemia among groups of patients were observed and compared.Results:The preoperative general data and PTH and blood calcium levels showed no significant differences among groups (all P>0.05).After surgery,both PTH and blood calcium levels were significantly decreased in all groups compared with their preoperative levels (all P
作者
吴润璋
袁盛
刘勇
李冠
张东海
张超杰
WU Runzhang;YUAN Sheng;LIU Yong;LI Guan;ZHANG Donghai;ZHANG Chaojie(Department of Breast and Thyroid Surgery,Hunan Provincial People's Hospital/the First Affiliated Hospital of Hunan Normal University,Changsha 410005,China;Department of Breast and Thyroid Surgery,Qidong County People's Hospital,Qidong,Hunan 421600,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第11期1357-1363,共7页
China Journal of General Surgery
基金
湖南省卫计委重点课题基金资助项目(A2017003)。
