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目的甲状腺乳头状癌行传统全甲状腺切除术后常见并发症为甲状旁腺功能低下,可引起严重低钙,患者极为痛苦,且无有效替代药物,极易引起医疗纠纷。本研究探讨改良Miccoli手术在全甲状腺切除中的安全性,从而有效保护甲状旁腺。方法回顾性分析2010-07-03-2015-07-19胜利油田中心医院乳腺甲状腺外科144例全甲状腺切除的甲状腺乳头状癌患者临床资料,根据治疗方法分成纳米碳组(A组)31例、改良Miccoli组(B组)71例和传统手术组(C组)42例,分析比较3组患者术后的甲状旁腺激素水平。结果A、B、C 3组患者术后第1天甲状旁腺激素水平分别为(7.85±2.45)、(5.39±2.15)和(4.50±1.83)pg/mL,3组之间差异均有统计学意义,F=23.123,P=0.001(A、B两组t=5.092,P<0.001;A、C两组t=6.697,P<0.001;B、C两组t=2.223,P=0.028);A、B、C 3组患者术后第7天甲状旁腺激素水平分别为(9.61±3.32)、(8.68±2.83)和(7.50±1.90)pg/mL;术后1个月甲状旁腺激素水平分别为(22.27±6.45)、(21.24±5.01)和(12.16±4.52)pg/mL。其中A、B两组术后7d(t=1.449,P=0.150)及术后1个月(t=0.793,P=0.432)甲状旁腺激素水平差异均无统计学意义,C组甲状腺旁腺激素水平明显低于A、B两组,与该两组相比术后7d及术后1个月甲状旁腺激素水平差异均有统计学意义,(术后第7天C、A两组t=0.197,P=0.003;C、B两组t=2.403,P=0.018;术后1个月C、A两组t=7.748,P<0.001,C、B两组t=9.654,P<0.001)。结论在全甲状腺切除时,改良Miccoli手术与纳米碳治疗效果相当,能安全有效的保护甲状旁腺,对于纳米碳显影不佳的部分患者,改良Miccoli手术可提供另外一种安全、有效的治疗方式。
Objective Thyroid papillary carcinoma after conventional total thyroidectomy is a common complication of parathyroid dysfunction, can cause severe hypocalcemia, the patient is extremely painful, and no effective alternative drugs, can easily lead to medical disputes. This study explored the safety of modified Miccoli surgery in total thyroidectomy to effectively protect the parathyroid gland. Methods Retrospective analysis of the clinical data of 144 cases of thyroidectomized thyroid papillary carcinoma in the Department of Breast Thyroid Surgery, Shengli Oilfield Central Hospital from July 31st to July 31st, 2010 were divided into three groups: group A (n = 31) 71 cases of modified Miccoli group (group B) and 42 cases of traditional surgery group (group C), the levels of parathyroid hormone in the three groups were analyzed. Results The levels of PTH on the first postoperative day in group A, B and C were (7.85 ± 2.45), (5.39 ± 2.15) and (4.50 ± 1.83) pg / mL, respectively There was a significant difference between the two groups (F = 23.123, P = 0.001, t = 5.092, P <0.001 for group A and B; . The levels of PTH on the 7th postoperative day were (9.61 ± 3.32), (8.68 ± 2.83) and (7.50 ± 1.90) pg / mL in group A, B and C respectively. The parathyroid hormone The hormone levels were (22.27 ± 6.45), (21.24 ± 5.01) and (12.16 ± 4.52) pg / mL, respectively. There was no significant difference in parathyroid hormone levels between group A and group B at 7 days after operation (t = 1.449, P = 0.150) and one month after operation (t = 0.793, P = 0.432) Hormone levels were significantly lower than the A and B groups, compared with the two groups after 7d and 1 month after the parathyroid hormone levels were statistically significant (on the 7th day C, A two groups t = 0.197, P = 0.003; t = 2.403, P = 0.018 in C and B groups; t = 7.748, P <0.001 in C and A groups at 1 month after operation ). Conclusions During total thyroidectomy, modified Miccoli surgery has the same effect as nanocarbon therapy and can safely and effectively protect the parathyroid gland. For some patients with poor nanocarbon imaging, modified Miccoli surgery can provide another safe and effective treatment .