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目的探讨甲状腺癌不同手术方式对甲状旁腺激素(parathyroid hormone,PTH)、血钙的影响,总结预防甲状旁腺功能减退发生的方法。方法回顾性分析作者医院2013-01/2014-12月期间234例甲状腺癌患者手术治疗的手术方式,观察甲状旁腺功能减退的发生率和术前术后PTH及血钙变化情况。结果术后甲状旁腺功能减退的总发生率29%,各种术式甲状旁腺功能减退的发生率依次为甲状腺全切除术+患侧颈淋巴结廓清术,甲状腺全切除术+双侧中央区淋巴结清扫,甲状腺全切除术+患侧中央区淋巴结清扫,甲状腺全切除术,单侧腺叶切除术+对侧腺叶近全切除术+患侧中央区淋巴结清扫;术后1 d PTH及血清钙水平较术前均有明显下降(P<0.05,P<0.01)。结论甲状腺癌不同手术方式和手术范围对甲状旁腺功能均有不同程度的影响,手术范围越大,术后发生甲状旁腺功能减退及低钙血症的可能性及程度就越大。预防甲状腺术后甲状旁腺功能减退的关键在于保护甲状旁腺及其血管。
Objective To investigate the effect of different surgical methods on parathyroid hormone (PTH) and serum calcium in thyroid cancer and to summarize the methods to prevent the hypoparathyroidism. Methods A retrospective analysis was performed on the surgical treatment of 234 cases of thyroid cancer from 2013-01 to 2014-12 in the author hospital. The incidence of hypoparathyroidism and changes of PTH and serum calcium were observed before and after operation. Results The overall incidence of postoperative hypoparathyroidism was 29%. The incidence of various types of parathyroid dysfunction followed by total thyroidectomy + ipsilateral neck lymph node dissection, total thyroidectomy + bilateral central region Lymph node dissection, total thyroidectomy + ipsilateral central lymph node dissection, total thyroidectomy, unilateral lobectomy + contralateral lobectomy + ipsilateral central lymph node dissection; 1 d postoperative PTH and serum Calcium levels were significantly lower than preoperative (P <0.05, P <0.01). Conclusions Different surgical methods and operative ranges of thyroid cancer have different effects on parathyroid function. The larger the scope of surgery, the greater the possibility and degree of postoperative hypoparathyroidism and hypocalcemia. The key to preventing parathyroid after thyroid surgery is to protect the parathyroid and its blood vessels.