甲状腺手术方式对甲状旁腺激素的影响.docVIP

甲状腺全切手术对甲状腺旁腺激素和血钙的影响 刘龙1 杨见明2 摘要 目的 探讨甲状腺全切术后的甲状腺旁腺激素（PTH）及血钙的变化，评估甲状腺旁腺功能，总结并预防甲状腺全切术后甲状旁腺功能减退（甲旁减）的发生及低钙血症的处理。方法 根据2013年2月-2014年9月73例在我院行甲状腺全切的患者，收集患者术前、术后1小时、1天、3天及5天的PTH及血钙值，根据手术范围将病人分为3组，比较各组间及组内的血PTH、血钙变化。结果 各组术后PTH、血钙较术前相比均明显下降（P＜0.05），其中手术前后的低PTH和低钙血症的发生：甲状腺全切除及双侧颈淋巴结清扫＞甲状腺全切除及单侧颈淋巴清除术＞甲状腺全切除术，有统计学意义（P＜0.05），另外全甲状腺切除术后1小时与术后1天血PTH能有效的预测低钙血症。 结论 甲状腺全切手术能影响甲状旁腺功能，手术范围越大，发生甲旁减及低钙血症的可能性增大，合理的术式、术中甲状旁腺的保护能减少甲旁减的发生，同时术后血清PTH能作为预测低钙血症的指标。 关键词 甲状腺全切术；甲状腺旁腺激素；甲状旁腺功能减退；低钙血症 The changes of parathyroid homone and serum calcium in total thyroidectomy LIU Long,YANG Jian-ming 【Abstract】 Objective To explore the changes of parathyroid hormone (PTH) and serum calcium after thyroidectomy and summarize the methods of preventing the hypoparathyroidism or hypocalcemia. Methods According to 73 patients with total thyroidectomy from Feb 2013-Sep 2014 in our hospital, the patients that has measured the serum concentration of PTH and calcium before and after surgery was classified in 3 groups.They were compared in terms of postoperative changes of PTH and serum calcium..Statistical analysis was performed．Results In each group,he serum concerntration of PTH and calcium were significantly decreased (P0.05).The result about comparions of low serum PTH and hypocalcemia are as follows: total thyroidectomy with bilateral compartment lymph node dissection(CLND)＞thyroidectomy with unilateral CLND＞thyroidectomy.The differences were statistically signifinat. PTH of postoperative 1 hour and 1 day has an effective the prediction of hypocalcemia. Conclusion Total thyroidectomy can affect the parathyroid function .The wider the surgery , the higher the possibility of postoperative hypoparathyroidism.Criteria of different types of thyroid surgery and the protection of parathyroid intraoperativily can decrease the hypoparathyroidism. Postoperative PTH predict postoperative hypocalcemia. 【Key Words】Total thyroidectomy；Parathyroid hormone；Hypoparathyroidism；Hypocalcemia 230000 安徽 合肥，安徽