甲状腺围手术期甲状旁腺素监测的临床应用及进展

尽管外科手术技术已取得巨大进步,但甲状旁腺功能减退仍是甲状腺全切除术后最常见的并发症之一,无论是术后短暂性还是永久性甲状旁腺功能减退均可导致严重的低钙血症,影响患者生活质量。因此,甲状腺术后低钙血症早期诊断及预测临床意义重大。因甲状旁腺素(PTH)由甲状旁腺直接分泌且凭其半衰期短的特征,临床上PTH既能实时反映甲状旁腺功能,又能体现术中PTH快速检查的意义。甲状腺围手术期PTH的监测应用于临床,具有实用性、有效性和经济性的优势。然而,对于甲状腺围手术期PTH监测的临床实际应用意义目前亦存在一些争议和问题,仍需要大宗病例前瞻性研究来确认。总之,围手术期PTH的监测有利于早期发现及预测低钙血症发生,优化临床管理策略和方法,合理指导术后补钙方案。笔者对围手术期PTH监测的方法和意义进行综述。

Clinical application and progress of parathyroid hormone monitoring in perioperative period of thyroid surgery

Despite the great progress in surgical techniques,hypoparathyroidism is still one of the most common complications after total thyroidectomy.Either transient or permanent hypoparathyroidism after operation can cause severe hypocalcemia and affect the patient’s quality of life.Therefore,early diagnosis and prediction of hypocalcemia after thyroid surgery are of great clinical significance.Because parathyroid hormone(PTH)is secreted directly by the parathyroid glands,plus its short half-life,PTH can not only reflect the function of the parathyroid glands in real time,but also reflect the significance of rapid intraoperative PTH testing.Perioperative PTH monitoring for thyroid surgery has the advantages of practicability,effectiveness and economic efficiency in clinical practice.However,there are still some controversies and problems about the actual significance of clinical application of PTH monitoring during perioperative period of thyroid surgery at present,which needs to be verified by prospective studies of a large sample size.In conclusion,perioperative PTH monitoring may be helpful for early detection and prediction of the occurrence of hypocalcemia,optimization of clinical management strategies and methods,and appropriately guiding the postoperative calcium supplementation regimen.Here,the author addresses the methods and significance of perioperative PTH monitoring.