CAJ | 학술논문

目的探讨促甲状腺激素(thyrotropic hormone,TSH)水平与胆总管结石复发之间的关系.方法分析在我院接受手术治疗的原发性或复发性胆总管结石患者268例.根据术前是否常规行TSH筛查将患者分组,未行TSH检测组171例,TSH检测组97例.比较两组术后36个月内胆总管结石复发率.结果未行TSH检测组和TSH检测组12、24、36个月复发率分别为3.5％、12.9％、16.9％和0.0％、5.2％、8.2％,差异有统计学意义(x2=4.029,P＜0.05).未行TSH检测组高龄(≥60岁)患者36个月累计复发率高于低龄(＜60岁)患者(x2=6.485,P＜0.05),TSH检测组高龄患者与低龄患者36个月累计复发率差异无统计学意义(x2=0.142,P＞0.05).TSH检测组共34例患者TSH水平升高,口服甲状腺制剂将TSH水平由(6.23±1.44) μIU/ml控制至(2.91±0.74) μIU/ml后,其12、24、36个月内复发率分别为0.0％、5.9％、8.8％,与TSH正常患者比较差异无统计学意义(x2=0.022,P＞0.05);此34例患者中低龄和高龄患者36个月内复发率比较差异无统计学意义(x2=0.086,P＞0.05).结论部分胆总管结石患者合并TSH水平升高,降低TSH水平可降低胆总管结石的复发率.
목적 탐토촉갑상선격소(thyrotropic hormone,TSH)수평여담총관결석복발지간적관계.방법 분석재아원접수수술치료적원발성혹복발성담총관결석환자268례.근거술전시부상규행TSH사사장환자분조,미행TSH검측조171례,TSH검측조97례.비교량조술후36개월내담총관결석복발솔.결과 미행TSH검측조화TSH검측조12、24、36개월복발솔분별위3.5％、12.9％、16.9％화0.0％、5.2％、8.2％,차이유통계학의의(x2=4.029,P＜0.05).미행TSH검측조고령(≥60세)환자36개월루계복발솔고우저령(＜60세)환자(x2=6.485,P＜0.05),TSH검측조고령환자여저령환자36개월루계복발솔차이무통계학의의(x2=0.142,P＞0.05).TSH검측조공34례환자TSH수평승고,구복갑상선제제장TSH수평유(6.23±1.44) μIU/ml공제지(2.91±0.74) μIU/ml후,기12、24、36개월내복발솔분별위0.0％、5.9％、8.8％,여TSH정상환자비교차이무통계학의의(x2=0.022,P＞0.05);차34례환자중저령화고령환자36개월내복발솔비교차이무통계학의의(x2=0.086,P＞0.05).결론 부분담총관결석환자합병TSH수평승고,강저TSH수평가강저담총관결석적복발솔.
Objective To investigate the impact of thyrotropic hormone (TSH) on recurrence rate of common bile duct stone (CBDS).Methods The clinical data of 268 cases of primary or recurrent CBDS undergoing surgery was analyzed.According to whether screening preoperative TSH level routinely,we assigned the patients into two groups,unchecked group with 171 cases and screened group with 97 cases.The postoperative recurrence rates in 36 months between two groups were compared.Results The recurrence rates of unchecked group and screened group were 3.5％,12.9％,16.9％ and 0.0％,5.2％,8.2％ respectively in 12-,24-,36-months,there was statistically significant difference between two groups (x2 =4.029,P ＜ 0.05).In unchecked group,patients ≥ 60 years had a significant higher recurrence rate than ＜ 60 years patients (x2 =6.485,P ＜ 0.05).In screened group,there was no statistically significant difference between ≥60 and ＜ 60 patients (x2 =0.142,P ＞ 0.05).In those 34 patients with a high TSH level in the screened group,normalizing the level from (6.23 ± 1.44) μIU/ml to (2.91 ±0.74) μIU/ml by oral intake of thyroid hormone postoperatively,led to the recurrence rates of 0％,5.9％,8.8％ in 12-,24-,36-months,which was not significantly different from those with normal TSH (x2 =0.022,P ＞ 0.05).And that,there was not statistically different between the young and elder patients in those 34 cases for the 12-,24-,36-month recurrence rates (x2 =0.086,P ＞ 0.05).Conclusions Some CBDS patients may be with high level of TSH.Normalizing TSH level may be conducive to a reduced postoperative recurrence rate of CBDS.