CAJ | 학술논문

目的：探讨甲状腺全切除术与非甲状腺全切除术对甲状腺癌患者喉返神经损伤及术后低钙血症发生情况的影响。方法回顾性分析2012年2月至2014年3月在延安市人民医院进行手术的103例甲状腺癌患者的临床资料,按照不同的手术方式分为甲状腺全切除术组( A组)42例,患侧腺叶及峡部切除组(B组)23例,患侧腺体叶及峡部加对侧大部切除术组(C组)38例。对各组患者喉返神经损伤、低钙血症的发生情况进行分析,同时对各组患者血钙含量和甲状旁腺激素分泌情况进行测定。结果 A组喉返神经损失发生率为19．0%(8/42),B组为4．4%(1/23),C组为2．4%(1/38),其中A组喉返神经损失发生率高于C组(P<0．05)。 A组低钙血症发生率为42．9%(18/42). B组为17．4%(4/23),C组为18．4%(7/38),其中A组患者低钙血症发生率显著高于B、C组(均P<0．05)。术后1~2 d三组患者血钙水平均降低,术后3 d血钙含量有所回升,其中以B组血钙含量回升最快,A组血钙含量回升最慢,组间、不同时点间、组间·不同时点间交互作用比较差异均有统计学意义(P<0．05)。术后A组患者甲状旁腺激素分泌量显著低于B组和C组(P<0．05),三组患者甲状旁腺激素分泌量均显著低于术前( P<0．05)。结论甲状腺全切除术相对于非全切除术可增加喉返神经损伤和低钙血症发生率,且对甲状旁腺功能影响较大。
목적：탐토갑상선전절제술여비갑상선전절제술대갑상선암환자후반신경손상급술후저개혈증발생정황적영향。방법회고성분석2012년2월지2014년3월재연안시인민의원진행수술적103례갑상선암환자적림상자료,안조불동적수술방식분위갑상선전절제술조( A조)42례,환측선협급협부절제조(B조)23례,환측선체협급협부가대측대부절제술조(C조)38례。대각조환자후반신경손상、저개혈증적발생정황진행분석,동시대각조환자혈개함량화갑상방선격소분비정황진행측정。결과 A조후반신경손실발생솔위19．0%(8/42),B조위4．4%(1/23),C조위2．4%(1/38),기중A조후반신경손실발생솔고우C조(P<0．05)。 A조저개혈증발생솔위42．9%(18/42). B조위17．4%(4/23),C조위18．4%(7/38),기중A조환자저개혈증발생솔현저고우B、C조(균P<0．05)。술후1~2 d삼조환자혈개수평균강저,술후3 d혈개함량유소회승,기중이B조혈개함량회승최쾌,A조혈개함량회승최만,조간、불동시점간、조간·불동시점간교호작용비교차이균유통계학의의(P<0．05)。술후A조환자갑상방선격소분비량현저저우B조화C조(P<0．05),삼조환자갑상방선격소분비량균현저저우술전( P<0．05)。결론갑상선전절제술상대우비전절제술가증가후반신경손상화저개혈증발생솔,차대갑상방선공능영향교대。
Objective To investigate the effect of total thyroidectomy and non-total thyroidectomy on recurrent laryngeal nerve injury and postoperative hypocalcemia of patients with thyroid cancer. Methods Medical records of 103 patients with thyroid cancer in Yan′an People′s hospital from Feb. 2012 to Mar. 2014 were retrospectively analyzed. They were divided into total thyroidectomy group(group A) of 42 cases,the affected lobe and isthmus resection group(group B) of 23 cases,and the ipsilateral gland lobe and isthmus plus contralateral subtotal resection group( group C) of 38 cases according to the different operating modes. Occurences of recurrent laryngeal nerve injury and hypocalcemia were analyzed,and the blood calcium levels and parathyroid hormone secretion were determined. Results The incidence of recurrent laryngeal nerve in group A was 19. 0% (8/42),of group B was 4. 4%(1/23),of group C was 2. 4%(1/38),and the inci-dence of recurrent laryngeal nerve in group A was higher than that in group C(P<0. 05). The incidence of hypocalcemia of group A was 42. 9% (18/42),of group B was 17. 4% (4/23),of group C was 18. 4% (7/38),hypocalcemia incidence of group A was significantly higher than that in group B and C(P<0. 05). Postoperative 1-2 d serum calcium level of each group decreased which all rebounded in the three groups, group B was the fastest, while group A was the slowest, difference between the groups, at different time points,group·time interaction were significant(P<0. 05). The secretion of parathyroid hormone in group A was significantly lower than that in group B and group C(P<0. 05),and the secretion of parathyroid hor-mone in the three groups was significantly lower than before operation(P<0. 05). Conclusion Compared with the non-total thyroidectomy,the total thyroidectomy increases the risk of recurrent laryngeal nerve injury and hypocalcemia,which also has greater influence on the function of parathyroid.