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目的探讨采用不同手术方式切除甲状腺的甲状腺癌患者手术前后血钙及血清甲状旁腺激素(PTH)水平的变化及临床意义。方法回顾性分析2012年1月至2013年6月在湖北医学院附属东风医院住院的行不同手术方式切除甲状腺的甲状腺癌患者,应用化学发光方法,动态检测手术前后血钙及血PTH水平的变化。结果 71例患者中32例出现暂时性甲状旁腺功能减退,发生率45.1%;38例发生低钙血症,发生率53.5%;7例发生症状性低钙血症,发生率23.9%。再次手术患者发生甲状旁腺功能减退及低钙血症的机率最高,甲状腺全切、次全切除患者甲状旁腺功能减退及低钙血症发生率最低。甲状腺术后血PTH值在1 h-1 d降至最低;血钙值在1~2 d降至最低;相关性分析显示血PTH值与血钙值呈正相关关系。结论甲状腺癌患者随着甲状腺手术范围的扩大,暂时性甲状旁腺功能减退及低钙血症的发生率增高,甲状腺癌患者应常规于术中1 h或术后1 d检测血PTH值,以预测低钙血症的发生。
Objective To investigate the changes of serum calcium and serum parathyroid hormone (PTH) level before and after thyroidectomy for thyroidectomy with different surgical approaches and their clinical significance. Methods A retrospective analysis of thyroid cancer patients undergoing thyroidectomy with different surgical approaches and hospitalized at Dongfeng Hospital Affiliated to Hubei Medical College from January 2012 to June 2013 was performed. The chemiluminescence was used to detect the change of serum calcium and blood PTH level before and after operation . Results 32 cases of 71 patients had transient hypoparathyroidism, the incidence rate was 45.1%; 38 cases of hypocalcemia, the incidence rate of 53.5%; 7 cases of symptomatic hypocalcemia, the incidence rate of 23.9%. Patients undergoing reoperation have the highest incidence of hypoparathyroidism and hypocalcemia. Patients with total thyroidectomy and subtotal resection have the lowest incidence of hypoparathyroidism and hypocalcemia. Thyroid surgery blood PTH decreased to a minimum in 1 h-1 d; serum calcium decreased to a minimum in 1 ~ 2 d; correlation analysis showed that blood PTH and serum calcium was positively correlated. Conclusions Thyroid cancer patients with the scope of the thyroid surgery to expand, temporary hypoparathyroidism and hypocalcemia increased incidence of thyroid cancer patients should routinely at 1 h or 1 d after surgery to detect blood PTH, with Predict the occurrence of hypocalcemia.