【作者】 苏畅；

【导师】 王贵民；

【作者基本信息】 吉林大学 ， 临床医学， 2013， 硕士

【摘要】 目的：探讨甲状腺全切除术的安全性及术中、术后对甲状旁腺功能的保护方法。方法：随机选取2012年4月至2012年10月于吉林大学白求恩第一医院甲状腺外科诊断为结节性甲状腺肿或甲状腺癌的同一手术组住院病人75例。将其随机分为对照组（A组）29例与实验组（B组）46例，两组患者均从术后当日起给予葡萄糖酸钙4克/日，此外实验组术后第1天开始使用参芎葡萄糖注射液200ml/d静脉滴注，疗程7天。两组均接受甲状腺全切除术，其中结节性甲状腺肿单纯行甲状腺全切除术组分别记为A1组8例、B1组21例，甲状腺癌行甲状腺全切除术联合中央区淋巴结清扫术分别记为A2组11例、B2组35例。记录比较分析各组术前、术后第1、3、5、7天、术后1个月血清钙离子及甲状旁腺激素水平以及是否出现低钙症状。结果:（1）所有患者术后均未发生永久性甲状旁腺功能减退和永久性低钙血症，暂时性甲状旁腺功能减退的发生率为53.33%（40/75），单纯行甲状腺全切除术的甲状旁腺减退发生率为15.79%（3/19），联合中央区淋巴结清扫的为66.07%（37/56）。（2）A1组术后第1、3、5、7天和一个月的PTH低于术前，有统计学差异，钙离子与术前无统计学差异；（3）A2组术后第1、3、5、7天和一个月的PTH和钙离子均低于术前，有统计学差异。（4）B1组术后第1、3、5、7天的PTH低于术前，有统计学差异，术后一个月PTH与术前无统计学差异；术后第1天钙离子低于术前，有统计学差异，术后第3、5、7天和一个月钙离子与术前无统计学差异；（5）B2组术后第1、3、5、7天和一个月的PTH低于术前，有统计学差异；术后第1、3、5、7天钙离子低于术前，有统计学差异，术后一个月钙离子和术前无统计学差异；（6）A1组、B1组PTH减低发生率分别低于A2组、B2组。结论：（1）单纯甲状腺全切和联合中央区淋巴结清扫术术后常并发暂时性甲状旁腺功能减低，后者尤甚。多数于一个月内恢复，永久性减低发生率很低，因此甲状腺癌行甲状腺全切联合中央区淋巴结清扫术是相对安全的。（2）对单纯甲状腺全切者术后常规补钙可避免低钙血症发生，而对联合中央区淋巴结清扫术者应提倡个体化治疗。（3）预防术后旁腺功能减退关键在于术中对其的保护。（4）参芎葡萄糖对单纯行甲状腺全切者可一定程度上促进甲状旁腺功能恢复；对联合中央区淋巴结清扫术者作用不明显。更多还原

【Abstract】 Objective: To investigate the safety of total thyroidectomy and the intraoperative andpostoperative protection method for parathyroid.Methods: Select randomly75inpatients diagnosed as nodular goiter or thyroid cancer,inthe same surgery group of First Hospital of Jilin University from April,2012to October,2012.These inpatients were seperated randomly into two groups:control group(A gruoup)29cases and test group (B group)56cases.Both groups accepted gluconate4g/d from onset ofsurgery day,and in addition test group accepted shenqiong glucose injection200ml/d for7days.Both groups accepted total thyroidectomy.And nodular goiter cases were respectivelymarked as A1group8cases and B1group21cases.Thyroid cancer patients accepted totalthyroidectomy combined with the lymph node in central region cleaning,and wererespectively marked as A2group11cases and B2group35cases.Compare and analyse serumcalcium ion,PTH and symptom of hypocalcemia of preoperative,postoperative1st,3rd,5th,7thdays,1month of every group.Results:(1)All patients did not have permanent hypoparathyroidism and permanenthypocalcemia,and the ratio of temporary hypoparathyroidism was53.33%（40/75）.The ratioof hypoparathyroidism of the group only accepting total thyroidectomy was15.79%(3/19),andthe ratio of hypoparathyroidism of the group accepting total thyroidectomy combined withcleaning of lymph node in central region cleaning was66.07%.(2) The PTH ofpostoperative1st,3rd,5th,7th days,1month of A1group were less than preoperative′s,havingsignificant differences,and calcium ion level has no significant difference between the twogroups above.(3)The PTH and calcium ion level of postoperative1st,3rd,5th,7th days,1month of A2group were less than preoperative′s,having significant differences.(4)The PTHof postoperative1st,3rd,5th,7th days of B1group were less than preoperative′s,havingsignificant differences;the PTH of preoperative level and postoperative level has nosignificant difference;The calcium ion level of postoperative1st day of B1group was lessthan preoperative′s,having significant difference;and The calcium ion level betweenpreoperative and postoperative3rd,5th,7th days and1month had no significant differences.(5)The PTH and calcium ion level of postoperative1st,3rd,5th,7th days,1month of B2group were less than preoperative′s,having significant differences;the calcium ion level ofpostoperative1st,3rd,5th,7th days were less than preoperative′s,having significantdifferences,and the postopreative1month calcium ion level of had no significant differencethan preoperative′s.（6）The ratios of hypothyroidism of A1group and B1group were lessrepectively than A2group and B2group.Conclusions:(1)The surgery of total thyroidectomy and total thyroidectomy combinedwith cleaning of lymph node in central region are often prone to cause temporaryhypoparathyroidism after surgery, the latter one more often and more severe.Most patientsrecover from the hypoparathyroidism in1month,and rarely step into the permanenthypoparathyroidism.So total thyroidectomy combined with cleaning of lymph node in centralregion is relatively safe.(2) For only total thyroidectomy,the gluconate injection from onset ofoperation day can avoid hypocalcemia.For total thyroidectomy combined with cleaning oflymph node in central region,individual therayp is advocated;(3)The key to prevent patientsfrom hypoparathyroidism is protection of parathyroid gland in surgery.(4)For totalthyroidectomy combined wtih cleaning of lymph node in central region,shenqiong glucoseinjection has no obvious effect for parathyroid gland function recovery.更多还原