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[目的]总结甲状腺癌手术中发生甲状旁腺损伤的危险因素和处理策略。[方法]回顾性分析405例甲状腺乳头状癌进行腺叶切除和中央区淋巴清扫时的手术方式、术后甲状旁腺素和血钙测定、临床有无甲状旁腺损伤表现等临床资料。[结果]405例甲状腺乳头状癌患者中,术后共出现甲状旁腺损伤症状28例,其中即刻血甲状旁腺激素(PTH)检查发现低于正常者22例,血钙低于正常者25例,通过静脉补钙,临床症状均消失;甲状旁腺损伤与年龄、性别、使用超声刀等因素无明显相关性(P>0.05),而与双侧腺叶全切和双侧Ⅵ区淋巴结清扫明显相关(P<0.05);在术中判断出现旁腺损伤并采用保护性措施(针刺除淤血、自体移植)后,术后发生甲状旁腺损伤症状与未发生损伤组相比无明显差异。[结论]甲状腺癌手术腺叶切除和中央区淋巴结清扫易发生甲状旁腺损伤,掌握正确的处理方法(腺体针刺清淤或旁腺移植)可以有效保护甲状旁腺。
[Objective] To summarize the risk factors and treatment strategies of parathyroid injury in thyroid cancer surgery. [Methods] A retrospective analysis of 405 cases of thyroid papillary thyroidectomy and central lymph node dissection, surgical methods, postoperative parathyroid hormone and serum calcium, clinical parathyroid injury clinical data. [Results] Among the 405 patients with papillary thyroid carcinoma, there were 28 cases of parathyroid injury after operation. Among them, 22 cases were found to have normal PTH and 22 cases were lower than normal Cases, through the intravenous calcium, clinical symptoms disappeared; parathyroid injury and age, gender, the use of ultrasonic scalpel and other factors was not significantly correlated (P> 0.05), and bilateral lobectomy and bilateral Ⅵ area lymph nodes (P <0.05). There was no significant difference in parathyroid gland injury between the two groups (P <0.05). After parathyroidectomy was identified and protective measures were adopted (acupuncture in addition to congestion and autologous transplantation) difference. [Conclusion] Parathyroidectomy and central lymph node dissection in thyroid cancer are prone to parathyroid injury. To master the correct treatment (gland acupuncture dredging or parathyroid gland transplantation) can effectively protect the parathyroid gland.