本文選題：甲狀腺 + 手術(shù)　； 參考：《河南大學(xué)》2015年碩士論文

【摘要】：目的:從接受甲狀腺手術(shù)患者的臨床資料入手,分析找出引發(fā)術(shù)后甲狀旁腺功能減退、低血鈣的影響因素,并進一步探討如何減少術(shù)后發(fā)生甲狀旁腺功能減退及低血鈣的發(fā)生。方法:回顧性分析河南省腫瘤醫(yī)院甲狀腺頸部外科于2013年3月至2014年2月收治的行甲狀腺手術(shù)的患者,共194例。收集患者的以下資料:性別、年齡、手術(shù)方式、術(shù)前甲狀旁腺激素(PTH)、術(shù)前血鈣、術(shù)后PTH、術(shù)后血鈣、病種(病理診斷)、術(shù)后有無低血鈣的自覺癥狀。分組后使用SPSS17.0軟件進行統(tǒng)計學(xué)分析。結(jié)果:194例患者中術(shù)后發(fā)生PTH水平較手術(shù)前降低的患者共158例,其中有53例出現(xiàn)甲狀旁腺功能減退;術(shù)后發(fā)生血鈣水平較術(shù)前降低的患者共190例,其中有146例發(fā)生低血鈣。術(shù)后出現(xiàn)低血鈣的自覺癥狀的患者有38例。統(tǒng)計分析結(jié)果顯示幾乎所有接受甲狀腺手術(shù)的患者在術(shù)后都有不同程度的PTH、血鈣水平較術(shù)前的下降。手術(shù)方式對術(shù)后PTH、血鈣的降低有影響,手術(shù)方式中,雙葉切除較單葉切除,術(shù)后發(fā)生PTH、血鈣水平較術(shù)前降低的概率大;年齡段、病種對術(shù)后PTH、血鈣的降低沒有影響;性別對術(shù)后PTH較術(shù)前降低似乎有些作用,但對術(shù)后血鈣水平的降低無影響。手術(shù)方式對術(shù)后甲狀旁腺功能減退、低鈣血癥的發(fā)生有影響,手術(shù)方式中,雙葉切除較單葉切除,術(shù)后甲狀旁腺功能減退、低鈣血癥發(fā)生的概率大,年齡段、性別、病種對術(shù)后甲狀旁腺功能減退、低鈣血癥的發(fā)生沒有影響。術(shù)后PTH、血鈣水平的下降具有普遍性,無法預(yù)測術(shù)后一定發(fā)生低血鈣的自覺癥狀,術(shù)后未發(fā)生低血鈣自覺癥狀也不能認為一定沒有發(fā)生PTH、血鈣水平的降低。低血鈣自覺癥狀的出現(xiàn)對PTH水平的降低有提醒作用,而無論有無低血鈣自覺癥狀的出現(xiàn),術(shù)后血鈣水平的降低似乎是普遍的情況。低血鈣自覺癥狀對術(shù)后甲狀旁腺功能減退、低鈣血癥的發(fā)生有提醒作用。結(jié)論:1.甲狀腺手術(shù)后PTH、血鈣水平較術(shù)前的下降具有普遍性,血鈣水平下降較PTH水平下降的概率更大;2.手術(shù)方式對術(shù)后PTH、血鈣水平的下降和術(shù)后甲狀旁腺功能減退、低鈣血癥的發(fā)生有影響,手術(shù)范圍越大,術(shù)后PTH、血鈣水平下降和術(shù)后甲狀旁腺功能減退、低鈣血癥的發(fā)生概率越大;淋巴結(jié)清掃范圍無此影響;3.年齡段、病種對術(shù)后PTH、血鈣的下降和術(shù)后甲狀旁腺功能減退、低鈣血癥的發(fā)生沒有影響,性別對術(shù)后PTH的降低似乎有些作用,但對術(shù)后血鈣水平的降低無影響,同時對術(shù)后甲狀旁腺功能減退、低鈣血癥的發(fā)生也沒有影響。
[Abstract]:Objective: to find out the influencing factors of hypothyroidism and hypoparathyroidism from the clinical data of patients undergoing thyroid surgery, and to explore how to reduce the incidence of hypothyroidism and hypocalcemia.Methods: 194 cases of thyroid surgery in Henan Cancer Hospital from March 2013 to February 2014 were retrospectively analyzed.The following data were collected: sex, age, operation mode, PTH, preoperative serum calcium, postoperative PTH, postoperative calcium, disease (pathological diagnosis, postoperative hypocalcemia or not).After grouping, SPSS17.0 software was used for statistical analysis.Results there were 158 cases with decreased PTH level after operation, 53 cases with hypoparathyroidism, and 190 cases with decreased serum calcium level after operation, including 146 cases with hypocalcemia.There were 38 patients with hypocalcemia after operation.Statistical analysis showed that almost all patients undergoing thyroid surgery had different levels of PTH, and the serum calcium level was lower than that before operation.The operation mode had an effect on the decrease of PTH and serum calcium. In the operation mode, the rate of PTH was higher after double lobectomy than that of single lobectomy, and the level of serum calcium was lower than that before operation, age, disease type had no effect on the decrease of PTH and serum calcium after operation.Sex seemed to have some effect on the decrease of PTH after operation, but had no effect on the decrease of serum calcium level after operation.The operation mode has influence on the occurrence of hypothyroidism and hypocalcemia after operation. In the operation mode, bilateral lobectomy is more than single lobectomy, postoperative hypoparathyroidism, hypocalcemia is more likely, age, sex,The incidence of hypoparathyroidism and hypocalcemia was not affected by the disease.The decrease of PTH and serum calcium level is universal, it is impossible to predict the spontaneous symptoms of hypocalcemia after operation, nor can it be considered that there is no PTH and the decrease of serum calcium level.The appearance of hypocalcemia may be a reminder of the decrease of PTH level, and whether or not hypocalcemia occurs, the decrease of serum calcium level seems to be common after operation.Hypocalcemia is a reminder of hypoparathyroidism and hypocalcemia.Conclusion 1.The decrease of serum calcium level after thyroid surgery was more common than that before operation, and the probability of the decrease of serum calcium level was higher than that of PTH level.The postoperative PTH, the decrease of serum calcium level and the decrease of parathyroid function and hypocalcemia after operation were affected by the operative method. The larger the scope of operation, the lower the serum calcium level, the lower the function of parathyroid gland after operation.The higher the probability of hypocalcemia, the greater the extent of lymph node dissection.Age group had no effect on PTH, serum calcium, hypothyroidism and hypocalcemia. Sex seemed to have some effect on the decrease of postoperative PTH, but had no effect on the decrease of serum calcium level.At the same time, the incidence of hypocalcemia and parathyroid hypothyroidism was not affected.
【學(xué)位授予單位】：河南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R653

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