甲状腺手术方式对甲状旁腺激素的影响.doc

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1、甲状腺全切手术对甲状腺旁腺激素和血钙的影响刘龙1杨见明2摘要目的探讨甲状腺全切术后的甲状腺旁腺激素（PTH）及血钙的变化，评估甲状腺旁腺功能，总结并预防甲状腺全切术后甲状旁腺功能减退（甲旁减）的发生及低钙血症的处理。方法根据2013年2月-2014年9月73例在我院行甲状腺全切的患者，收集患者术前、术后1小时、1天、3天及5天的PTH及血钙值，根据手术范围将病人分为3组，比较各组间及组内的血PTH、血钙变化。结果各组术后PTH、血钙较术前相比均明显下降（P＜0.05），其中手术前后的低PTH和低钙血症的发生：甲状腺全切除及双侧颈淋巴结清扫＞甲状腺全切除及单侧颈淋巴清除术＞甲

2、状腺全切除术，有统计学意义（P＜0.05），另外全甲状腺切除术后1小时与术后1天血PTH能有效的预测低钙血症。结论甲状腺全切手术能影响甲状旁腺功能，手术范围越大，发生甲旁减及低钙血症的可能性增大，合理的术式、术中甲状旁腺的保护能减少甲旁减的发生，同时术后血清PTH能作为预测低钙血症的指标。关键词甲状腺全切术；甲状腺旁腺激素；甲状旁腺功能减退；低钙血症ThechangesofparathyroidhomoneandserumcalciumintotalthyroidectomyLIULong,YANGJian-ming【Abstract】ObjectiveToexploret

3、hechangesofparathyroidhormone(PTH)andserumcalciumaftertotalthyroidectomyandsummarizethemethodsofpreventingthehypoparathyroidismorhypocalcemia.MethodsAccordingto73patientswithtotalthyroidectomyfromFeb2013-Sep2014inourhospital,thepatientsthathasmeasuredtheserumconcentrationofPTHandcalciumbef

4、oreandaftersurgerywasclassifiedin3groups.TheywerecomparedintermsofpostoperativechangesofPTHandserumcalcium..Statisticalanalysiswasperformed．ResultsIneachgroup,The230000安徽合肥，安徽医科大学第二附属医院耳鼻咽喉头颈外科serumconcerntrationofPTHandcalciumweresignificantlydecreased(P<0.05).Theresultaboutcomparionsoflo

5、wserumPTHandhypocalcemiaareasfollows:totalthyroidectomywithbilateralcompartmentlymphnodedissection(CLND)＞totalthyroidectomywithunilateralCLND＞totalthyroidectomy.Thedifferenceswerestatisticallysignifinat.PTHofpostoperative1hourand1dayhasaneffectivethepredictionofhypocalcemia.ConclusionTotal

6、thyroidectomycanaffecttheparathyroidfunction.Thewiderthesurgery,thehigherthepossibilityofpostoperativehypoparathyroidism.Criteriaofdifferenttypesofthyroidsurgeryandtheprotectionofparathyroidintraoperativilycandecreasethehypoparathyroidism.PostoperativePTHpredictpostoperativehypocalcemia.【K

7、eyWords】Totalthyroidectomy；Parathyroidhormone；Hypoparathyroidism；Hypocalcemia