双侧甲状腺切除术后甲状旁腺功能减退临床因素分析及防治

目的:探讨双侧甲状腺切除术后患者甲状旁腺功能减退与各临床因素的关系,总结术后甲状旁腺功能减退的预防和治疗。方法:2011年1—12月行双侧甲状腺手术患者193例,所有患者于术后第1、2天检测血钙及甲状旁腺素(PTH),术后1、3、6个月随访血钙和PTH。术后PTH低于正常值患者予口服碳酸钙和维生素D。结果:193例患者中25例(13.0%)出现甲状旁腺功能减退,其中19例(9.8%)为暂时性甲状旁腺功能减退,6例(3.1%)为永久性甲状旁腺功能减退。不同年龄、性别患者术后甲状旁腺功能减退发生率差异无统计学意义(P>0.05)。甲状腺恶性肿瘤、术中行淋巴结清除患者术后甲状旁腺功能减退发生率(24.7%、20.9%)高于良性肿瘤、未行淋巴结清除患者(5.2%、8.7%,P<0.01、P<0.05)。术中有甲状旁腺误切患者与无误切患者术后甲状旁腺功能减退发生率差异无统计学意义(24.0%vs 11.3%,P=0.08)。永久性甲状旁腺功能减退患者中行颈淋巴结清除者100%(6/6)、甲状旁腺误切者83.3%(5/6),两者比例均高于暂时性甲状旁腺功能减退患者(P<0.05、P<0.01)。25例甲状旁腺功能减退患者补充碳酸钙和维生素D后1例出现低钙血症。结论:甲状旁腺功能减退与患者的年龄、性别无关,与患者手术范围有关,颈淋巴结清除和甲状旁腺误切更易导致永久性甲状旁腺功能减退。术后选择性补充碳酸钙和维生素D可以有效减少低钙血症的发生。

Analysis of the clinical factors and treatment effect of hypoparathyroidism after bilateral thyroidectomy

Objective： The most common complication following a bilateral thyroidectomy ishypoparathyroidism. The aim of this study was to analysis of the clinical factors of hypoparathy- roidism after bilateral thyroidectomy and the medical treatment to prevent hypocalcaemia. Metl- ods： We studied 193 bilateral thyroidectomy patients between January 2011 and November 2011. PTH and serum calcium level were assayed 1 day before, 1 day, 2 days, 1 month, 3 months and 6 months after thyroidectomy.