甲状腺全切除术中保护甲状旁腺功能研究分析

目的：总结甲状腺全切除术中甲状旁腺功能的保护方法。方法回顾性分析2009年10月至2014年6月收治的42例行甲状腺全切除术患者的临床资料，比较手术前后血清甲状旁腺激素（PTH）、血钙水平变化。结果术后PTH暂时低下者19例（45.2%），低钙血症者9例（21.4%），术后30 d复查血清PTH及血钙均恢复正常，未见永久性甲状旁腺功能低下的病例。术后第1、3、5天，血清PTH较术前明显降低（P〈0.05），而术后30 d，血清PTH与术前无显著性差异（P〉0.05）。血钙水平除了术后第1天、第3天低于术前（P〈0.05），其余时间点与术前均无显著性差异（P〉0.05）。结论甲状腺全切除术中加强对甲状旁腺解剖位置的辨别、血供的保护，可有效减少术后甲状旁腺的损伤，避免严重并发症的发生。

Protection experience of parathyroid glands in total thyroidectomy

Objective To summarize the protection method of parathyroid glands in total thyroidectomy. Methods Clinical data of 42 patients who were treated by total thyroidectomy in our hospital from 2009.10 to 2014.6 were retrospectively analyzed. The level of serum PTH and calcium before and after surgery were compared. Result 19 cases （45.2%）had decreased PTH and 9 cases（21.4%）had complicated symptomatic hypocalcemia,but the level of serum PTH and calcium return to normal at 30 days after surgery. Perpetual hypoparathyroidism was not found. The level of serum PTH was significantly decreased（P〈0.05）,while there was no difference at 30 days after surgery（P〉0.05）,and without difference on the level of serum calcium except that at 1st and 3rd day after surgery,as compared to that before surgery. Conclusions Identify of parathyroid anatomical location and protection of blood supply in total thyroidectomy can effectively reduce postoperative parathyroid damage,avoid severe complications.