甲状腺乳头状癌中央区淋巴结清扫术中保留甲状旁腺的分析(1)
[摘要] 目的 探討甲状腺乳头状癌中央区淋巴结清扫术中保留甲状旁腺的体会。方法 方便收集2015年2月—2017年4月该院收治的甲状腺乳头状癌的患者60例，ASAⅠ～Ⅱ级，男性12例，女性48例，年龄31～59岁，根据患者手术方法分为两组：研究组(接受中央区清除)和对照组(接受同侧改良清除)。分析两组患者手术情况，对比研究组和对照组手术前与手术后不同时间甲状旁腺素与血清钙水平；研究组和对照组甲状旁腺功能减退与低血清钙发生情况；两组患者术后并发症。结果 ①研究组和对照组手术前甲状旁腺素与血清钙水平[(41.25±8.65)pg/mL、 (2.33±0.13)mmol/L vs (41.19±8.34)pg/mL、(2.32±0.15)mmol/L]比较差异无统计学意义(P>0.05)；研究组和对照组手术后1、3 d甲状旁腺素与血清钙水平[(25.43±6.34)pg/mL、(17.63±5.34)pg/mL、(2.10±0.12)mmol/L、(2.29±0.12)mmol/L]、(20.13±5.78)pg/mL、(14.23±4.97)pg/mL、(1.73±0.15)mmol/L、(2.05±0.11)mmol/L]比较差异有统计学意义(P<0.05)。②研究组和对照组甲状旁腺功能减退与低血清钙发生情况分别为(10%、2%)、(30%、10%)，比较差异有统计学意义(P<0.05)。③研究组和对照组甲状腺乳头状癌术后并发症发生率分别为3.3%、6.6%，比较差异无统计学意义(P>0.05)。结论 甲状腺乳头状癌手术中，给予中央区淋巴结清扫术伴保留甲状旁腺时，术后甲状旁腺功能减退与低血清钙发生情况低，优于同侧颈部淋巴结改良颈清除术。
[关键词] 甲状腺；乳头状癌；淋巴结清扫术；甲状旁腺
[中图分类号] R736 [文献标识码] A [文章编号] 1674-0742(2017)11(b)-0013-03
[Abstract] Objective This paper tries to explore the experience of parathyroid retained lymph node of thyroid papillary carcinoma resection in central region. Methods Patients with papillary thyroid cancer in this hospital from February 2015 to April 2017 with ASA I～II were collected， 12 cases were male， 48 were female， aged between 31 to 59 years old， according to the patient’s surgical methods， they were divided into two groups： the study group (receiving central clearance) and the control group (receiving ipsilateral modified clearance). The surgical situation of the two groups of patients was analyzed， the parathyroid hormone and serum calcium levels， the incidence of hypoparathyroidism with low serum calcium and postoperative complications before and after operation in different time in the study group and the control group were compared. Results ①the parathyroid hormone and serum calcium levels in the study group and the control group before the operation were [(41.25±8.65)pg/mL， (2.33±0.13)mmol/L， (41.19±8.34)pg/mL， (2.32±0.15)mmol/L] without significant difference (P>0.05)； the parathyroid hormone and serum calcium levels in the study group and the control group for 1 day after surgery， 3 days were [(25.43±6.34)pg/mL， (17.63±5.34)pg/mL， (2.10±0.12)mmol/L， (2.29±0.12)mmol/L， (20.13±5.78)pg/mL， (14.23±4.97)pg/mL， (1.73±0.15)mmol/L， (2.05±0.11)mmol/L]， with significant difference (P<0.05). ②the incidence of hypoparathyroidism and low serum calcium in the study group and the control group were (10%， 2%)， (30%， 10%)， there were significant differences (P<0.05). ③the incidence of postoperative complications of thyroid papillary carcinoma in the study group and the control group was 3.3%， 6.6% respectively， without significant difference(P>0.05). Conclusion Thyroid papillary carcinoma surgery， given the central area of lymph node dissection with preserved parathyroid gland， with low incidence of postoperative hypoparathyroidism and low serum calcium， better than ipsilateral cervical lymph node repair neck dissection., 百拇医药(傅鸿亮 陈春明 马系国)
[关键词] 甲状腺；乳头状癌；淋巴结清扫术；甲状旁腺
[中图分类号] R736 [文献标识码] A [文章编号] 1674-0742(2017)11(b)-0013-03
[Abstract] Objective This paper tries to explore the experience of parathyroid retained lymph node of thyroid papillary carcinoma resection in central region. Methods Patients with papillary thyroid cancer in this hospital from February 2015 to April 2017 with ASA I～II were collected， 12 cases were male， 48 were female， aged between 31 to 59 years old， according to the patient’s surgical methods， they were divided into two groups： the study group (receiving central clearance) and the control group (receiving ipsilateral modified clearance). The surgical situation of the two groups of patients was analyzed， the parathyroid hormone and serum calcium levels， the incidence of hypoparathyroidism with low serum calcium and postoperative complications before and after operation in different time in the study group and the control group were compared. Results ①the parathyroid hormone and serum calcium levels in the study group and the control group before the operation were [(41.25±8.65)pg/mL， (2.33±0.13)mmol/L， (41.19±8.34)pg/mL， (2.32±0.15)mmol/L] without significant difference (P>0.05)； the parathyroid hormone and serum calcium levels in the study group and the control group for 1 day after surgery， 3 days were [(25.43±6.34)pg/mL， (17.63±5.34)pg/mL， (2.10±0.12)mmol/L， (2.29±0.12)mmol/L， (20.13±5.78)pg/mL， (14.23±4.97)pg/mL， (1.73±0.15)mmol/L， (2.05±0.11)mmol/L]， with significant difference (P<0.05). ②the incidence of hypoparathyroidism and low serum calcium in the study group and the control group were (10%， 2%)， (30%， 10%)， there were significant differences (P<0.05). ③the incidence of postoperative complications of thyroid papillary carcinoma in the study group and the control group was 3.3%， 6.6% respectively， without significant difference(P>0.05). Conclusion Thyroid papillary carcinoma surgery， given the central area of lymph node dissection with preserved parathyroid gland， with low incidence of postoperative hypoparathyroidism and low serum calcium， better than ipsilateral cervical lymph node repair neck dissection., 百拇医药(傅鸿亮 陈春明 马系国)