甲状腺癌不同手术方式对术后甲状旁腺功能和低钙血症的影响

摘要

目的：探讨甲状腺癌不同手术方式和范围对患者术后甲状旁腺功能和低钙血症的影响。方法回顾性分析2012年6月至2014年5月因甲状腺癌行甲状腺次全切除和甲状腺全切患者115例，按手术切除范围分为甲状腺次全切除、甲状腺全切术、甲状腺全切＋颈淋巴结清扫组，对比分析各组术前及术后甲状旁腺素（PTH）及血钙水平的变化。结果甲状腺次全切除、甲状腺全切、甲状腺全切＋颈部淋巴结清扫术患者术后甲状旁腺功能低下者比率分别为13.2％、31.4％和73.8％，出现低钙血症者和症状性低钙血症者的比率分别为15.8％、34.3％、73.8％和5.3％、20％和47.6％。甲状腺全切＋颈淋巴结清扫组 PTH 及血钙水平异常的患者比率明显高于甲状腺次全切除组和甲状腺全切术组，组间差异有显著性（ P ＜0.05）。总的低钙血症和症状性低钙血症发生率为42.6％和 25.5％。结论甲状腺癌不同的手术方式和手术范围对患者术后甲状旁腺功能和血钙有显著影响，应根据不同病变范围选择适当的手术方式。%Objective To investigate the effect of different therapeutic choice and extent of thyroidectomy to the postoperative parathyroid function and hypocalcemia. Methods One hundred and fifteen patients of thyroid carcinomas underwent subtotal or total thyroidectomy June 2012 to May 2014 from our hospital were reviewed retrospectively. They were allocated into three groups according to operative extent:subtotal thyroid-ectomy,total thyroidectomy,total thyroidectomy plus lateral neck dissection. Pre and postoperative serum PTH and calcium levels were analyzed in each group. Results Post - thyroidectomy parathyroid dysfunction occurred in 13. 2% ,31. 4% and 73. 8% patients who underwent subtotal thy-roidectomy,total thyroidectomy,total thyroidectomy plus neck dissection respectively. Hypocalcemia and symptomatic hypocalcemia occurred in 15. 8% ,34. 3% ,73. 8% and 5. 3% ,20% ,47. 6% patients respectively. The patients abnormal ratio of PTH and serum calcium levels in total thyroidectomy + neck dissection group was significantly higher than the group subtotal thyroidectomy and total thyroidectomy group,the difference between groups was significant( P < 0. 05). The overall rates of hypocalcemia and symptomatic hypocalcemia were 42. 6% ,25. 5% . Conclusion The postoperative parathyroid function and serum calcium were significantly associated with thyroidectomy types and operative extent. The opti-mal operative types should be chosen based on the extent of disease.