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目的探讨手术方式对甲状腺乳头状癌术后甲状旁腺功能的影响。方法甲状腺乳头状癌患者104例分为三组,分别行甲状腺(患侧腺叶+峡部)切除+同侧中央区淋巴结清扫(A组,26例)、甲状腺全切除+同侧中央区淋巴结清扫(B组,48例)和甲状腺全切除+双侧中央区淋巴结清扫(C组,30例)。检测术后第1天和术后1年血清甲状旁腺激素(PTH)和血钙水平,比较术后甲状旁腺功能低下发生率。结果术后第1天及术后1年,A组无甲状旁腺功能低下病例,B组甲状旁腺功能低下发生率为33.3%和4.2%,低于C组的50.0%和10.0%(P<0.05)。A组术后第1天血清PTH和血钙水平均高于B、C组(P<0.05)。A、B组术后1年血清PTH均高于C组(P<0.05)。结论甲状腺(患侧腺叶+峡部)切除+同侧中央区淋巴结清扫术式是甲状腺乳头状癌患者安全、有效的手术选择。
Objective To investigate the effect of surgical methods on parathyroid function after thyroid papillary carcinoma (PTC). Methods Thirty-six patients with papillary thyroid carcinoma were divided into three groups: thyroid (ipsilateral lobes plus isthmuses) and ipsilateral central lymph nodes (group A, n = 26), total thyroidectomy plus ipsilateral central lymph node dissection (Group B, 48 cases) and total thyroidectomy + bilateral central lymph node dissection (group C, 30 cases). Serum parathyroid hormone (PTH) and serum calcium levels were measured on the first postoperative day and one year postoperatively, and the incidence of postoperative hypoparathyroidism was compared. Results On the first day after operation and one year after operation, there was no case of hypothyroidism in group A, the incidence of hypoparathyroidism in group B was 33.3% and 4.2%, which was lower than that in group C (50.0% and 10.0%, P <0.05). On the first day after operation, serum PTH and serum calcium in group A were higher than those in group B and C (P <0.05). Serum PTH in group A and B at 1 year after operation was significantly higher than that in group C (P <0.05). Conclusions Thyroid (ipsilateral lobectomy + isthmus) resection + ipsilateral central lymph node dissection is a safe and effective surgical choice for patients with thyroid papillary carcinoma.