甲状腺癌根治术致甲状旁腺功能减退的危险因素及预防

目的:探讨甲状腺癌根治术中可能导致甲状旁腺功能减退的危险因素及预防措施。方法:回顾性分析首都医科大学附属北京同仁医院普通外科2014年全年由同一外科医师实施的75例甲状腺癌手术的临床资料。结果:全组术后发生甲状旁腺功能减退20例(26.67%),其中暂时性甲状旁腺功能减退19例(25.33%),永久性甲状旁腺功能减退1例(1.33%)。甲状腺全切术患者甲状旁腺功能减退发生率明显高于甲状腺近全切除术患者(46.88%vs.11.63%,P0.05);行VI区淋巴结清扫患者甲状旁腺功能减退发生率明显高于未行VI区淋巴结清扫患者(45.71%vs.10.00%,P0.05);同时行自体甲状旁腺移植术患者甲状旁腺功能减退发生率高于未行甲状旁腺移植患者,但差异无统计学意义(50.00%vs.22.22%,P0.05)。结论:甲状腺全切和Ⅵ区淋巴结清扫是导致甲状旁腺功能减退的危险因素。术中精细解剖甲状腺后被膜,尤其是尽可能保留下甲状旁腺血运,术后应用预防性药物可能有助于甲状旁腺功能的保护。

Risk factors and prevention of hypoparathyroidism following thyroid cancer surgery

Objective: To investigate the risk factors for hypoparathyroidism following radical surgery for thyroid carcinoma and preventive measures. Methods: The clinical data of 75 cases of thyroid cancer surgery performed during the entire year of 2014 by the same main surgeon in Department of General Surgery of Beijing Tongren Hospital affiliated to Capital Medical University were retrospectively analyzed. Results: Hypoparathyroidism occurred in 20 patients (26.67%) in the entire group, including 19 cases (25.33%) of transient hypoparathyroidism and one case (1.33%) of permanent hypoparathyroidism. The incidence of postoperative hypoparathyroidism in patients undergoing total thyroidectomy was significantly higher than that in those undergoing nearly total thyroidectomy (46.88% vs. 11.63%, P<0.05), in patients receiving level VI neck dissection was significantly higher than that in those without level VI neck dissection (45.71% vs. 10.00%, P<0.05), and in patients with simultaneous autologous parathyroid transplantation was higher than that in those without parathyroid transplantation, but the difference did not reach statistical significance (50.00% vs. 22.22%, P>0.05). Conclusion: Total thyroidectomy and level VI neck dissection are risk factors for postoperative hypoparathyroidism. Meticulous dissection of the posterior thyroid capsule, especially maintaining the blood supply to the inferior parathyroid glands as best as possible, and postoperative use of preventive medicine may be helpful for protecting parathyroid function.