本文關(guān)鍵詞： 甲狀旁腺 自體移植 甲狀腺全切除術(shù)　出處：《青海大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:在全甲狀腺切除術(shù)中,對(duì)甲狀旁腺的原位保留及自體移植進(jìn)行臨床觀察,為甲狀旁腺自體移植在臨床中有效應(yīng)用提供理論依據(jù)。方法:收集青海大學(xué)附屬醫(yī)院乳腺甲狀腺外科在2013年3月至2014年12月期間行甲狀腺全切除術(shù)的患者70例,將他們分為觀察組和對(duì)照組,各35例。兩組均行甲狀腺全切除術(shù):觀察組術(shù)中暴露并保護(hù)甲狀旁腺,對(duì)誤切或者瘀血變色血供不足者的旁腺移植于胸鎖乳突肌內(nèi);對(duì)照組不完全暴露甲狀旁腺,不作甲狀旁腺自體移植術(shù)。2組患者術(shù)前常規(guī)檢查Ca和PTH濃度,術(shù)后1d、3d、5d及1月檢測(cè)Ca和PTH濃度。術(shù)后觀察對(duì)比兩組患者發(fā)生甲狀旁腺功能減退和低鈣血癥的情況,判定移植后甲狀旁腺能否存活分泌甲狀旁腺激素。結(jié)果:(1)表3.1、表3.2表明兩組患者術(shù)前性別以及手術(shù)方式均無(wú)差異,P0.05。(2)表3.3表明兩組術(shù)后PTH變化,觀察組PTH升高趨勢(shì)明顯好于對(duì)照組,1月后兩組患者基本完全恢復(fù),術(shù)后第1、3、5d無(wú)差異,1月后P0.05,差異有統(tǒng)計(jì)學(xué)意義。(3)表3.5中兩組病人術(shù)后第1d、第3d均出現(xiàn)低鈣血癥伴有程度不同的手腳、口周麻木感,第5d后觀察組低鈣癥狀消失,1月后,觀察組患者術(shù)后恢復(fù)較好,P0.05。(4)表3.7中出現(xiàn)暫時(shí)性低鈣血癥觀察組3(8.5%),對(duì)照組10(28.5%),P0.05。(5)表3.8中移植2、3枚甲狀旁腺,甲狀旁腺功能低下的發(fā)生率分別為14.2%、10.0%明顯低于移植1枚甲狀旁腺的發(fā)生率54.5%,P0.05差異有統(tǒng)計(jì)學(xué)意義。(6)術(shù)后出現(xiàn)低鈣癥狀的患者均予以口服或靜脈補(bǔ)鈣,大部分患者在術(shù)后5~7天癥狀消失,表3.4、表3.6表明患者術(shù)后1月比術(shù)前完全恢復(fù),P0.05差異有統(tǒng)計(jì)學(xué)意義,無(wú)一例發(fā)生永久性甲狀旁腺功能低下。結(jié)論:甲狀旁腺自體移植大大降低了術(shù)后甲狀旁腺功能低下的發(fā)生率;移植的甲狀旁腺以2-3枚效果最好,移植時(shí)將甲狀旁腺盡可能切成小小的組織勻漿,這樣甲狀旁腺會(huì)更快恢復(fù)分泌功能;移植的甲狀旁腺在術(shù)后1個(gè)月內(nèi)即可恢復(fù)分泌功能。
[Abstract]:Objective: to observe the orthotopic preservation and autologous transplantation of parathyroid gland in total thyroidectomy. To provide theoretical basis for the effective application of parathyroid autograft in clinic. Methods:. A total of 70 patients underwent total thyroidectomy from March 2013 to December 2014 in the Department of Breast thyroid surgery, affiliated Hospital of Qinghai University. They were divided into observation group (n = 35) and control group (n = 35). Total thyroidectomy was performed in both groups: exposure of parathyroid gland and protection of parathyroid gland were performed in observation group. The paracentral glands were transplanted into the sternocleidomastoid muscle of the patients with miscut or blood stasis discoloration. The control group was not completely exposed to parathyroid gland, and the concentration of Ca and PTH in group 2 was not examined before operation, and the concentration of Ca and PTH was 3 days after operation. The concentrations of Ca and PTH were measured on day 5 and January. The hypoparathyroidism and hypocalcemia were observed and compared between the two groups. Results Table 3.1 and Table 3.2 showed that there was no difference between the two groups in terms of preoperative sex and operation methods. P0.05 / 2) Table 3.3 showed that the change of PTH was significantly better in the observation group than in the control group. After January, the patients in the two groups recovered completely, and there was no difference between the two groups on the 1st and 3rd day after operation. After January, the difference was statistically significant (P 0.05) in Table 3.5, hypocalcemia accompanied with different degrees of hands and feet, perioral numbness occurred in both groups on the 1st and 3rd day after operation. After 5 days, the symptoms of hypocalcemia disappeared in the observation group, and after January, the patients in the observation group recovered better after operation (P 0.05. 05. 4) Table 3. 7 showed temporary hypocalcemia in the observation group (3: 8. 5). In the control group, 3 parathyroid glands were transplanted, and the incidence of hypoparathyroidism was 14.2%. 10.0% was significantly lower than the incidence of a parathyroid gland transplantation 54.5 / P0.05 the difference was statistically significant (P < 0.05) the patients with hypocalcemia symptoms were given oral or intravenous calcium supplementation. Most of the patients in 5 days after the symptoms disappeared, table 3.4, table 3. 6 shows that the postoperative January complete recovery than the preoperative P05 difference was statistically significant. There was no permanent hypoparathyroidism. Conclusion: autologous transplantation of parathyroid gland can greatly reduce the incidence of postoperative hypoparathyroidism. Transplantation of 2-3 parathyroid glands the best effect, the transplantation of parathyroid glands as much as possible into small tissue homogenate, so that the parathyroid gland will restore the secretory function faster; The transplanted parathyroid gland can recover its secretory function within 1 month after operation.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R653

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