三种甲状腺全切除术式的临床疗效及对甲状旁腺功能的影响对比

目的探讨不同术式甲状腺全切术的临床疗效及对甲状旁腺功能的影响。 方法回顾性分析2014年1月至2017年1月间收治的86例甲状腺乳头状癌患者的临床资料，根据手术方式不同分为3组，A组(25例，常规甲状腺全切术治疗)，B组(32例，注射纳米碳示踪剂后，行甲状腺全切术治疗)，C组(29例，改良Miccoli手术治疗)，采用SPSS22.0软件对数据进行统计学分析，临床疗效、血清钙离子及甲状旁腺激素(PTH)水平以( ±s)表示，采用独立t检验；甲状旁腺误切率、低血钙与甲状旁腺功能减退的发生率等组间比较采用χ²检验，均以P<0.05为差异有统计学意义。 结果三组患者手术时间、术中出血量、淋巴结清扫数量均无明显差异(P>0.05); B、C组患者甲状旁腺误切率明显低于A组；3组患者术后血清钙和PTH水平较术前明显下降(P<0.05), B、C组患者术后血清钙和PTH水平明显高于A组(P<0.05); B组、C组低血钙与甲状旁腺功能减退的发生率明显低于A组(P<0.05)。 结论改良Miccoli手术和联合应用纳米碳治疗甲状腺乳头状癌与常规甲状腺全切术效果相当，且对甲状旁腺具有保护作用，可有效降低甲状旁腺的误切率及甲状旁腺功能减退发生率。

Clinical effects of three kinds of total thyroidectomy and its Influence on parathyroid function

ObjectiveTo investigate the clinical effects of different kinds total thyroidectomy and its influence on parathyroid function. MethodsRetrospective analysis of 86 patients with thyroid papillary carcinoma from January 2014 to January 2017 was performed, the patients were divided into three group according to the method of the surgery. group A (25 cases, underwent routine total thyroidectomy), group B (32 cases, injected with nano-carbon tracers before surgery), group C (29 cases, underwent improved Miccoli surgery). Clinical data were analyzed by using statistical software SPSS 20.0, measurement data such as clinical effects, serum calcium and PTH level were expressed as and were examined by using t test. Count data, such as incidences of mis-resection, hypocalcemia and hypoparathyroidism were examined by using Chi-square test. A P value<0.05 was considered as statistically significant difference. ResultsThere was no significant difference between 3 groups in operation time, intraoperative blood loss and number of removed lymph nodes (P>0.05). The mis-resection of parathyroid of the group B, C were significantly lower than that of the group A (P<0.05). The level of serum calcium and PTH of the three groups were significantly decreased (P<0.05). The level of serum calcium and PTH of the group B, C were significantly higher than those of the group A (P<0.05), the incidences of hypocalcemia and hypoparathyroidism of the group B, C were significantly lower than those of the group A (P<0.05). ConclusionThe improved Miccoli surgery and combined use of nano-carbon for the treatment of thyroid papillary carcinoma is safe and effective with an equal therapeutic effect to that of routine total thyroidectomy, which can protect the parathyroid, reduce the mis-resection rate of parathyroid, as well as the incidences of hypoparathyroidism.