中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2012年
2期
324-326
,共3页
耿中利%孙刚%马斌林%任光辉%单美慧
耿中利%孫剛%馬斌林%任光輝%單美慧
경중리%손강%마빈림%임광휘%단미혜
甲状腺癌%次全切除术%甲状腺功能
甲狀腺癌%次全切除術%甲狀腺功能
갑상선암%차전절제술%갑상선공능
Thyroid cancer%Subtotal thyroidectomy%Thyroid function
目的 观察甲状腺癌行甲状腺叶全切或次全切术后甲状腺功能的变化,为术后补充甲状腺素提供时间和量的依据.方法 对我院2009年1月至2011年4月间行甲状腺叶全切或次全切除的88例甲状腺癌患者术前(0 d)、术后第1天(1 d)、术后第3天(3 d)和术后第5天(5 d)的甲状腺功能[游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、血清三碘甲腺原氨酸(T3)、四碘甲腺原氨酸(T4)、促甲状腺激素(TSH)]进行检测,对比手术前后变化规律.结果 88例行甲状腺叶全切或次全切除患者的FT3和T3在各时点均呈下降趋势,差异有统计学意义(FT3:F =47.752,P＜0.01；T3:F=15.317,P＜0.01),且术后3d起FT3和T3逐渐上升接近正常值下限；FT4和T4术后1d均上升,随后逐渐下降,FT4值在0d、术后1d及5d差异无统计学意义(P＞0.05),T4值在0d、术后1d差异无统计学意义(P＞0.05),其余各时间点间差异均有统计学意义(P＜0.05)；TSH在术后1d下降,3d及5d逐渐上升,TSH值在0d、术后1d差异无统计学意义(P＞0.05),其余各时间点间差异均有统计学意义(P＜0.05),且TSH在术后3d接近正常值上限,于术后5d超过正常值上限.结论 甲状腺癌患者行甲状腺全切或次全切除术后1d甲状腺功能不降或下降不明显,可不检测甲状腺功能和补充甲状腺激素；术后3d起甲状腺功能明显下降,应及时监测,并根据甲状腺功能下降情况适当补充甲状腺激素.
目的 觀察甲狀腺癌行甲狀腺葉全切或次全切術後甲狀腺功能的變化,為術後補充甲狀腺素提供時間和量的依據.方法 對我院2009年1月至2011年4月間行甲狀腺葉全切或次全切除的88例甲狀腺癌患者術前(0 d)、術後第1天(1 d)、術後第3天(3 d)和術後第5天(5 d)的甲狀腺功能[遊離三碘甲腺原氨痠(FT3)、遊離甲狀腺素(FT4)、血清三碘甲腺原氨痠(T3)、四碘甲腺原氨痠(T4)、促甲狀腺激素(TSH)]進行檢測,對比手術前後變化規律.結果 88例行甲狀腺葉全切或次全切除患者的FT3和T3在各時點均呈下降趨勢,差異有統計學意義(FT3:F =47.752,P＜0.01；T3:F=15.317,P＜0.01),且術後3d起FT3和T3逐漸上升接近正常值下限；FT4和T4術後1d均上升,隨後逐漸下降,FT4值在0d、術後1d及5d差異無統計學意義(P＞0.05),T4值在0d、術後1d差異無統計學意義(P＞0.05),其餘各時間點間差異均有統計學意義(P＜0.05)；TSH在術後1d下降,3d及5d逐漸上升,TSH值在0d、術後1d差異無統計學意義(P＞0.05),其餘各時間點間差異均有統計學意義(P＜0.05),且TSH在術後3d接近正常值上限,于術後5d超過正常值上限.結論 甲狀腺癌患者行甲狀腺全切或次全切除術後1d甲狀腺功能不降或下降不明顯,可不檢測甲狀腺功能和補充甲狀腺激素；術後3d起甲狀腺功能明顯下降,應及時鑑測,併根據甲狀腺功能下降情況適噹補充甲狀腺激素.
목적 관찰갑상선암행갑상선협전절혹차전절술후갑상선공능적변화,위술후보충갑상선소제공시간화량적의거.방법 대아원2009년1월지2011년4월간행갑상선협전절혹차전절제적88례갑상선암환자술전(0 d)、술후제1천(1 d)、술후제3천(3 d)화술후제5천(5 d)적갑상선공능[유리삼전갑선원안산(FT3)、유리갑상선소(FT4)、혈청삼전갑선원안산(T3)、사전갑선원안산(T4)、촉갑상선격소(TSH)]진행검측,대비수술전후변화규률.결과 88례행갑상선협전절혹차전절제환자적FT3화T3재각시점균정하강추세,차이유통계학의의(FT3:F =47.752,P＜0.01；T3:F=15.317,P＜0.01),차술후3d기FT3화T3축점상승접근정상치하한；FT4화T4술후1d균상승,수후축점하강,FT4치재0d、술후1d급5d차이무통계학의의(P＞0.05),T4치재0d、술후1d차이무통계학의의(P＞0.05),기여각시간점간차이균유통계학의의(P＜0.05)；TSH재술후1d하강,3d급5d축점상승,TSH치재0d、술후1d차이무통계학의의(P＞0.05),기여각시간점간차이균유통계학의의(P＜0.05),차TSH재술후3d접근정상치상한,우술후5d초과정상치상한.결론 갑상선암환자행갑상선전절혹차전절제술후1d갑상선공능불강혹하강불명현,가불검측갑상선공능화보충갑상선격소；술후3d기갑상선공능명현하강,응급시감측,병근거갑상선공능하강정황괄당보충갑상선격소.
Objective To investigate the change of thyroid function after total or subtotal thyroidectomy.Methods During January 2009 to April 2011,88 cases of thyroid cancer undergoing total or subtotal thyroidectomy were enrolled to detect thyroid function before surgery (0 d),postoperative day 1 (1 d),3 (3 d) and 5 (5 d),including T3,T4,FT3,FT4 and TSH,and their changing patterns were analyzed.Results FT3 and T3 expressed a downward trend,the changes were statistically significant (FT3:F =47.752,P ＜ 0.01; T3:F =15.317,P ＜ 0.01 ),and both of the values on 3 d were close to the lower limit of normal level; FT4 and T4 levels were increased after 1 d,then decreased gradually.Changes of FT4 on 0 d,1 d and 5 d had no significant difference (P ＞ 0.05),those of T4 on 0 d and 1 d had no statistically significant difference (P ＞ 0.05),and those at the remaining time points had statistically significant difference (P ＜ 0.05).TSH level was declined on 1 d,but gradually increased on 3 d and 5 d.TSH level on 0 d and 1 d had no statistically significant difference ( P ＞ 0.05 ),and those on the remaining time points had statistically significant difference ( P ＜ 0.05 ).TSH level on 3 d was close to the upper limit of normal level,and greater than that on 5 d.Conclusion Thyroid function after total or subtotal thyroidectomy does not decrease or decrease mildly on 1 d after surgery.There is no need to test thyroid function or supply thyroid hormone at this time.Thyroid function after surgery is significantly decreased from 3 d,thyroid function should be monitored,and according to the level of thyroid function,proper thyroid hormone should be given.
