CAJ | 학술논문

目的探讨甲状腺不同术式术后甲状旁腺素(PTH)和血钙的变化，总结预防甲状腺术后甲状旁腺功能低下（甲旁减）、低钙血症等的发生。方法检测2006年8月至2009年12月470例不同术式甲状腺手术术前和术后第1天血清PTH和血钙，比较其变化，并按手术范围大小及相近似分为7组比较不同范围手术术后PTH和血钙的变化，行统计学分析。结果甲状腺不同术式手术前后血清PTH、血钙（除一侧和双侧腺叶部分切除外）差异有统计学意义(P＜0.05)。双侧次全切、一叶加对侧次全切，尤其是甲状腺近全切、全切术后PTH和血钙下降幅度、低血钙症发生率及发生临床症状者与一叶切除、一叶加对侧部分或大部切除者差异有统计学意义(P＜0.05)。颈淋巴清扫术后PTH和血钙下降幅度、低PTH和低钙血症发生率及发生临床症状者和未清扫者间差异有统计学意义(P＜0.05)。结论各种术式甲状腺手术均可影响甲状旁腺功能，手术范围越大术后并发甲旁减可能越大。预防甲状腺术后甲旁减的发生，除手术操作外，掌握手术指征、选择合理术式，酌情预防性使用维生素D和钙制剂。
목적 탐토갑상선불동술식술후갑상방선소(PTH)화혈개적변화，총결예방갑상선술후갑상방선공능저하（갑방감）、저개혈증등적발생。방법검측2006년8월지2009년12월470례불동술식갑상선수술술전화술후제1천혈청PTH화혈개，비교기변화，병안수술범위대소급상근사분위7조비교불동범위수술술후PTH화혈개적변화，행통계학분석。결과 갑상선불동술식수술전후혈청PTH、혈개（제일측화쌍측선협부분절제외）차이유통계학의의(P＜0.05)。쌍측차전절、일협가대측차전절，우기시갑상선근전절、전절술후PTH화혈개하강폭도、저혈개증발생솔급발생림상증상자여일협절제、일협가대측부분혹대부절제자차이유통계학의의(P＜0.05)。경림파청소술후PTH화혈개하강폭도、저PTH화저개혈증발생솔급발생림상증상자화미청소자간차이유통계학의의(P＜0.05)。결론각충술식갑상선수술균가영향갑상방선공능，수술범위월대술후병발갑방감가능월대。예방갑상선술후갑방감적발생，제수술조작외，장악수술지정、선택합리술식，작정예방성사용유생소D화개제제。
Objective To investigate the changes of serum concentration of parathyroid hormone (PTH) and calcium after thyroid surgery and compare the changes among different modes of operation. Methods From Aug. 2006 to Dec. 2009, 470 patients accepted thyroid surgery. The serum concentration of PTH and calcium in different groups was measured and compared before and 1 day after surgery. According to the extent and similarity of the surgery, patients were classified into 7 groups and they were compared in terms of postoperative changes of PTH and serum calcium. Statistical analysis was performed. Results The serum concentration of PTH and calciurn decreased significantly after surgery in all patients except for those receiving unilateral and bilateral partial thyroidectomy. Compared with unilateral lobectomy, surgeries such as bilateral subtotal thyroidectomy, unilateral thyroidectomy with contralateral subtotal thyroidectomy, bilateral near-total thyroidectomy and total thyroidectomy resulted in more dramatic decreases of serum concentration of PTH and calcium and higher incidence of hypocalcemia ( P ＜ 0.05 ). The comparison between patients receiving CLND or not had the same result. Conclusions Almost all kinds of thyroid surgery affect the parathyroid function. The wider the surgery, the higher the possibility of postoperative hypoparathyroidism. The indications and criteria of different types of thyroid surgery are essential for hypoparathyroidism prevention. In some cases, vitamin D and calcium are recommended for preventive purpose.