三种甲状腺手术方法对甲状腺、甲状旁腺功能的影响分析

目的探讨三种甲状腺手术方法对甲状腺癌患者甲状腺、甲状旁腺功能的影响。方法回顾性分析2012年至2015年手术治疗的甲状腺癌患者125例,根据手术方式分为3组,其中A组57例行甲状腺全切+颈淋巴结清扫术,B组36例行甲状腺全切除术,C组32例行甲状腺次全切除术。数据分析用SPSS16.0软件进行,甲状腺功能、甲状旁腺功能和血清钙中的指标用均数±标准差(x珋±s)表示,t检验;低血钙发生率用百分率(%)表示,卡方检验;P0.05表示差异具有统计学意义。结果手术后3 d三组患者的T3和FT3以及T4和FT4均显著低于术前,而TSH显著高于术前(P0.05);C组患者的PTH(29.6±12.6)pg/ml显著高于A、B组的患者,且差异具有统计学意义(F=4.568,P0.05);三组甲状腺癌患者术后血清钙均下降,且差异具有统计学意(P0.05),而C组患者的血清钙显著高于A、B组的患者,且术后低血钙发生率(18.7%)也显著低于A(59.6%)、B组(41.67%)的患者,差异均具有统计学意义(P0.05)。结论手术治疗对甲状癌患者的甲状腺功能以及甲状旁腺功能均有显著影响,不同手术方式对甲状腺功能的影响无显著差异,而随着甲状腺手术方式和范围的扩大甲状旁腺功能减退和低血钙发生率增高。

Influence of 3 kinds of thyroid operation on the thyroid and parathyroid function

Objective To investigate the influence of 3 kinds of thyroid operation on the thyroid and parathyroid function of patients with thyroid carcinoma.Methods From 2012 to 2015,retrospective analysis were performed in 125 patients with thyroid carcinoma,who underwent thyroid surgery,including 57 cases in A group with total thyroidectomy and neck lymph node dissection,36 cases in B group with total thyroidectomy,and 32 cases in C group of with subtotal thyroidectomy.Statistical analysis were performed by using SPSS16.0 software.The measurement data were expressed as mean ± standard deviation ((x) ± s),were examined by using t test,including thyroid function,parathyroid function and serum calcium.Count data such as hypocalcemia incidence were examined by using x2 test.A P value ＜ 0.05 was considered as statistically significant difference.Results T3 and FT3,T4 and FT4 on postoperation 3 days were significantly decreased,while TSH was significantly increased than preoperarive index in all of 3 groups.(P ＜ 0.05);PTH of (29.6 ± 12.6) pg/ml in C group was significantly higher than those in A or B group,with significant difference (F =4.568,P ＜ 0.05);The serum calcium levels in three groups were significantly decreased (P ＜ 0.05),And the serum calcium in C group was significantly higher than those in A or B group,and the postoperative hypocalcemia occurred rate in C group (18.7％) was significantly lower than those in A group (59.6％) or in B group (41.67％),with significant difference (P ＜ 0.05).Conclusion Surgical treatment had significant effect on thyroid function and parathyroid function of patients with thyroid cancer.There was no significant difference of thyroid function by different operation methods,however the extent of thyroid surgery might increase hypoparathyroidism and the incidence of hypocalcemia.