| 梅俊.双侧甲状腺乳头状癌行甲状腺全切除和双侧中央区颈清扫术时对甲状旁腺的术中保护[J].安徽医药,2016,20(12):2316-2319. |
| 双侧甲状腺乳头状癌行甲状腺全切除和双侧中央区颈清扫术时对甲状旁腺的术中保护 |
| Protective effect on parathyroid gland of total thyroidectomy and bilateral central neck dissection surgery in patients with bilateral thyroid papillary carcinoma |
| 投稿时间：2015-12-23 |
| DOI： |
| 中文关键词: 双侧甲状腺乳头状癌 甲状腺全切除术 甲状旁腺 双侧中央区颈清扫术 |
| 英文关键词: Bilateral thyroid papillary carcinoma Total thyroidectomy Parathyroid gland Bilateral central neck dissection |
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| 中文摘要: |
| 目的 分析双侧甲状腺乳头状癌行甲状腺全切除术和双侧中央区颈清扫术术中保护甲状旁腺的作用。方法 选取66例行甲状腺全切除术＋双侧中央区颈清扫术的双侧甲状腺乳头状癌患者,收集完整临床治疗资料以及术后随访资料并加以分析。结果 22例患者发生术后面部、唇部或手足部的针刺感、麻木感或强直感并发症,总发生率为33.33%,只有2例永久性的甲状旁腺功能低下(3.03%),其他暂时性的甲状旁腺功能低下16例(24.24%)、暂时性的声音嘶哑4例(6.06%)。手术前血钙值与手术后1 d、手术后7 d相比明显降低,差异有统计学意义(P＜0.05),在手术后14 d恢复至手术前水平,差异无统计学意义(P＞0.05)；手术前甲状旁腺激素(PTH)值与手术后1、7、14 d相比明显降低,差异有统计学意义(P＜0.05),手术后1个月PTH值恢复至手术前水平,差异无统计学意义(P＞0.05)。甲状旁腺的保留个数与低钙血症和甲状旁腺功能低下的发生率呈反比,甲状旁腺的保留个数越多,低钙血症和甲状旁腺功能低下的发生率越低,差异有统计学意义(χ2=19.90、15.53,P=0.000 52、0.003 72,P＜0.008 3)。保留1个和保留4个甲状旁腺的甲状旁腺素降低率、低钙血症相比差异有统计学意义(χ2=10.40、14.60,P=0.001 26、0.000 13,P＜0.008 3)；保留2个和保留4个甲状旁腺的甲状旁腺素降低率、低钙血症相比差异有统计学意义(χ2=10.51、15.80,P=0.001 19、0.000 0,P＜0.008 3)。结论 双侧甲状腺乳头状癌患者采取全切术联合中央区颈清扫术效果较好,虽然并发症发生率高,但恢复都较快,且在手术中也注意了对甲状旁腺的保护。 |
| 英文摘要: |
| Objective To analyze the protective effect of total thyroidectomy and bilateral central neck dissection on parathyroid gland in patients with bilateral thyroid papillary carcinoma.Methods Sixty-six patients undergoing total thyroidectomy and bilateral central neck dissection were selected to collect and analyze their complete data of clinical treatment and follow-up.Results The total incidence of complications including tingling,numbness or stiffness of patients′ face,lips or limbs was 33.33%.There were 2 (3.03%) cases of permanent hypoparathyroidism,other temporary hypoparathyroidism (24.24%),and temporary hoarseness (6.06%).Calcium value before surgery was significantly lower than postoperative calcium value 1 d and 7 d after surgery (P<0.05).The calcium value restored to the preoperative level at 14 d after surgery,and the difference was not statistically significant (P>0.05).Preoperative parathyroid hormone (PTH) value was significantly lower than postoperative PTH 1 d,7 d and 14 d after surgery,and the difference was not statistically significant (P<0.05).One month after surgery PTH returned to preoperative level,and the difference was not statistically significant (P>0.05).The number of retained parathyroid was inversely proportional to the incidence of hypocalcemia and hypoparathyroidism.The more the reserved parathyroid,the lower incidence of hypocalcemia and hypoparathyroidism.The difference was statistically significant (χ2=19.90,5.53,P=0.000 52,0.003 72,P<0.008 3).There was difference in decreased rate of parathormone and hypocalcemia between retaining 1 parathyroid gland and retaining 4 parathyroid glands,and the difference was statistically significant (χ2=10.40,4.60,P=0.001 26,0.000 13,P<0.008 3).There was difference in decreased rate of parathormone and hypocalcemia between retaining 2 parathyroid glands and retaining 4 parathyroid glands (χ2=10.51,5.80,P=0.001 19,0.000 0,P<0.008 3).Conclusions Bilateral papillary thyroid carcinoma treated with total resection combined with central neck dissection achieves better efficacy.Although there is a high incidence of complications,but patients can recover soon.Such therapy has obvious protective effect on parathyroid. |
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