CAJ | 학술논문

目的：监测甲状腺癌行甲状腺全切除术（TT）后甲状旁腺激素（PTH）水平变化，分析影响甲状旁腺功能减退的因素。方法选取2013年11月—2014年10月天津医科大学总医院收治的行 TT 的甲状腺癌患者113例，分别于术前及术后24 h 内监测血清 PTH，分析性别、年龄、手术方式、甲状旁腺保留方式、甲状腺癌合并桥本甲状腺炎与超声刀使用等因素对术后血 PTH 的影响。结果根据术后血 PTH 水平，将患者分为 PTH 正常组59例，PTH 降低组47例，PTH 升高组7例。3组性别、年龄、超声刀使用率比较，差异均无统计学意义（ P ﹥0.05）。3组手术范围、甲状旁腺保留方式、桥本甲状腺炎合并率比较，差异均有统计学意义（P ﹤0.05）。66例（58.4％）患者术后出现暂时性低钙血症，随访1个月后未发现永久性低钙血症。结论颈淋巴结清扫和甲状旁腺原位保留是影响 TT 后甲状旁腺功能的主要因素，术中淋巴结清扫时应仔细分离并原位保留或移植保留2枚以上甲状旁腺，对合并桥本甲状腺炎的病例更应重视，以减少术后甲状旁腺功能减退的发生。
목적：감측갑상선암행갑상선전절제술（TT）후갑상방선격소（PTH）수평변화，분석영향갑상방선공능감퇴적인소。방법선취2013년11월—2014년10월천진의과대학총의원수치적행 TT 적갑상선암환자113례，분별우술전급술후24 h 내감측혈청 PTH，분석성별、년령、수술방식、갑상방선보류방식、갑상선암합병교본갑상선염여초성도사용등인소대술후혈 PTH 적영향。결과근거술후혈 PTH 수평，장환자분위 PTH 정상조59례，PTH 강저조47례，PTH 승고조7례。3조성별、년령、초성도사용솔비교，차이균무통계학의의（ P ﹥0.05）。3조수술범위、갑상방선보류방식、교본갑상선염합병솔비교，차이균유통계학의의（P ﹤0.05）。66례（58.4％）환자술후출현잠시성저개혈증，수방1개월후미발현영구성저개혈증。결론경림파결청소화갑상방선원위보류시영향 TT 후갑상방선공능적주요인소，술중림파결청소시응자세분리병원위보류혹이식보류2매이상갑상방선，대합병교본갑상선염적병례경응중시，이감소술후갑상방선공능감퇴적발생。
Objective To monitor the change of parathyroid hormone(PTH)level after total thyroidectomy(TT)for thyroid carcinoma,to analysis the influencing factors for function of the parathyroid decline. Methods We enrolled 113 patients with thyroid carcinoma who received TT in the General Hospital of Tianjin Medical University from November 2013 to October 2014. Before surgery and within 24 hours after surgery,patients' serum PTH was monitored. And we analyzed the influence of gender,age,the operation mode,the retaining method of parathyroid, thyroid carcinoma complicated with hashimoto thyroiditis and the use of ultrasound knife on postoperative serum PTH. Results According to postoperative serum PTH,the patients were divided into normal PTH group(n = 59),low PTH group(n = 47)and high PTH group(n = 7). The three groups were not significantly different(P ﹥ 0. 05)in gender,age and the use of ultrasound knife. The three groups were significantly different(P ﹤ 0. 05)in the scope of surgery,the retaining method of parathyroid and thyroid carcinoma complicated with hashimoto thyroiditis. There were 66 patients(58. 4% )who had temporal hypocalcemia after surgery,and no patients had permanent hypocalcemia after a month' s follow - up. Conclusion Cervical lymph node dissection and the retaining of parathyroid at in - situ are two major influencing factors for parathyroid function. During lymph node dissection,separation should be made carefully,and more than two parathyroid glands should be preserved at in - situ or transplanted for preservation. More attention should be given to patients complicated with hashimoto thyroiditis,in order to eliminate the deterioration of parathyroid function.