本文選題：甲狀腺結(jié)節(jié) + 甲狀腺切除術(shù)��； 參考：《吉林大學(xué)》2016年碩士論文

【摘要】：近年來我國甲狀腺結(jié)節(jié)的發(fā)病率逐年增高。手術(shù)是治療甲狀腺良惡結(jié)節(jié)的常用手段。通過動(dòng)態(tài)觀察甲狀腺不同術(shù)式術(shù)后早期甲狀腺激素的變化規(guī)律,指導(dǎo)甲狀腺術(shù)后內(nèi)分泌治療適宜的起始時(shí)間,減少醫(yī)源性并發(fā)癥的發(fā)生率,提高甲狀腺結(jié)節(jié)患者的術(shù)后生活質(zhì)量,使甲狀腺術(shù)后的內(nèi)分泌治療更加科學(xué)規(guī)范。目的:動(dòng)態(tài)研究甲狀腺不同術(shù)式術(shù)后早期甲狀腺激素變化規(guī)律。探討不同術(shù)式下甲狀腺術(shù)后給予內(nèi)分泌治療的適宜的起始時(shí)間。方法:選取2014年1月至2015年12月期間于吉林大學(xué)第二醫(yī)院甲狀腺外科行手術(shù)治療的符合選擇及排除標(biāo)準(zhǔn)的患者120例。按其手術(shù)方式分為四組,單側(cè)甲狀腺次全切除術(shù)組30例,雙側(cè)甲狀腺次全切除術(shù)組30例,患側(cè)甲狀腺及峽部全切除術(shù)組30例,雙側(cè)甲狀腺全切除術(shù)組30例。四組患者分別采集術(shù)后第1、3、5、7、14天空腹靜脈血。應(yīng)用ADVIA Centaur?XP全自動(dòng)免疫分析系統(tǒng)及配套試劑采用電化學(xué)發(fā)光免疫分析法檢測相應(yīng)時(shí)段血清甲狀腺激素水平。其中雙側(cè)甲狀腺全切除組和患側(cè)甲狀腺及峽部全切除組60名患者術(shù)后病理證實(shí)為惡性。結(jié)果:對(duì)比觀察120例患者術(shù)前及術(shù)后早期檢測的甲狀腺激素水平變化。甲狀腺全切除術(shù)組術(shù)后血清tt3、ft3逐漸下降,于術(shù)后第5天略有升高,后再逐漸下降,但術(shù)后各時(shí)間點(diǎn)測得結(jié)果與術(shù)前比較均低于術(shù)前(p0.05);血清tt4、ft4術(shù)后第1天呈一過性上升趨勢,后逐漸下降,術(shù)后第5天明顯低于術(shù)前(p0.05),術(shù)后第7天降至正常低值附近,術(shù)后第14天明顯低于正常低值(p0.05);血清tsh術(shù)后第1天呈一過性下降,后逐漸上升,于術(shù)后第3天明顯高于術(shù)前(p0.05),術(shù)后第5天超過正常值高限,后繼續(xù)升高�；紓�(cè)甲狀腺腺葉全切及峽部全切除術(shù)組血清tt3、ft3術(shù)后第1天、術(shù)后第3天一過性下降,術(shù)后第5天開始逐漸上升,術(shù)后各個(gè)時(shí)間點(diǎn)測得血清tt3、ft3值低于術(shù)前水平(p0.05);血清tt4、ft4術(shù)后第1天一過性升高,明顯高于術(shù)前(p0.05),之后逐漸下降,于術(shù)后第14天降到正常低值附近;血清tsh術(shù)后第1天一過性下降,明顯低于術(shù)前(p0.05),后逐漸上升,于術(shù)后第7天明顯高于術(shù)前(p0.05),術(shù)后第14天明顯超出正常值高值。雙側(cè)甲狀腺次全切除術(shù)組血清tt3、ft3術(shù)后逐漸下降,術(shù)后第7天明顯低于術(shù)前(p0.05),低于正常參考值下限,后逐漸上升,術(shù)后第14天與術(shù)前無明顯差異(p0.05);血清tt4、ft4術(shù)后第1天術(shù)后第1天一過性升高,明顯高于術(shù)前(p0.05),后逐漸下降,術(shù)后第14天明顯低于術(shù)前(p0.05),血清tt4降到正常值低限附近,血清ft4低于正常值低限;血清tsh術(shù)后一過性下降,明顯低于術(shù)前(p0.05),之后逐漸上升,術(shù)后第7天明顯高于術(shù)前(p0.05),高于正常值高限。單側(cè)甲狀腺次全切除組血清TT3、FT3術(shù)后一過性下降,術(shù)后第3天明顯低于術(shù)前(P0.05),后逐漸上升,術(shù)后第14天仍低于術(shù)前;血清TT4、FT4術(shù)后第1天一過性升高,明顯高于術(shù)前(P0.05),后逐漸下降,術(shù)后第7天明顯低于術(shù)前(P0.05),后逐漸上升,血清TT4術(shù)后14天與術(shù)前無明顯差異(P0.05);血清TSH術(shù)后第1天一過性下降,明顯低于術(shù)前(P0.05),后逐漸升高,第7天明顯高于術(shù)前,后逐漸下降,術(shù)后第14天仍高于術(shù)前,但未超過正常值高值。結(jié)論:甲狀腺不同術(shù)式術(shù)后早期甲狀腺激素呈動(dòng)態(tài)變化,且變化趨勢不同;根據(jù)甲狀腺手術(shù)切除范圍的不同,術(shù)后早期血循環(huán)中甲狀腺激素變化趨勢不同,給予外源性甲狀腺激素替代治療及TSH抑制治療的起始時(shí)間不同。單側(cè)甲狀腺切除術(shù)切除術(shù)后剩余甲狀腺代償功能較好,可在術(shù)后一個(gè)月內(nèi)給予相對(duì)少量或不給予外源性甲狀腺激素替代治療;雙側(cè)甲狀腺次全切除術(shù)后剩余甲狀腺代償功能不良,可在術(shù)后14左右給予外源性甲狀腺激素替代治療;雙側(cè)甲狀腺全切除術(shù)后,可在術(shù)后第5天左右給予外源性甲狀腺激素行TSH抑制治療;患側(cè)甲狀腺及峽部全切除術(shù)后,可在術(shù)后第14天左右給予外源性甲狀腺激素行TSH抑制治療。因存在個(gè)體差異,所有患者應(yīng)根據(jù)相應(yīng)時(shí)間的甲狀腺激素水平制定個(gè)體化的治療方案。
[Abstract]:In recent years, the incidence of thyroid nodules in China is increasing year by year. Surgery is a common means for the treatment of thyroid benign and malignant nodules. Through dynamic observation of the changes in the early thyroid hormone after different thyroidectomy, the appropriate starting time of endocrine therapy after thyroid surgery is guided, the incidence of iatrogenic complications is reduced, and the thyroid is improved. The postoperative quality of life of the patients with nodules makes the endocrine treatment more scientific after thyroid surgery. Objective: to dynamically study the changes in the early thyroid hormone changes after different thyroidectomy. The appropriate starting time for the treatment of endocrine therapy after different surgical thyroidectomy was discussed. Methods: from January 2014 to December 2015. In the second hospital of Jilin University, 120 cases of surgical treatment of thyroid surgery were divided into four groups, 30 cases with unilateral subtotal thyroidectomy, 30 cases of bilateral thyroidectomy, 30 cases of lateral thyroid and isthmus resection, 30 cases of bilateral total thyroidectomy. Four groups of patients. The blood of the 1,3,5,7,14 sky abdominal vein was collected after the operation. The serum thyroid hormone levels were detected by the ADVIA Centaur? XP automatic immunoassay system and the auxiliary reagents by electrochemiluminescence immunoassay. 60 patients with bilateral thyroid total excision group and the affected side thyroid and isthmus total excision group were treated after surgical pathology. Results: the changes of thyroid hormone levels were observed in 120 patients before and after the operation. The serum TT3, FT3 decreased gradually after the total thyroidectomy group, slightly increased at the fifth day after the operation, and then decreased gradually, but the results were lower than before the operation (P0.05) after the operation (P0.05); serum TT4, FT4 after operation. The 1 day showed an upward trend, then decreased gradually, after fifth days obviously lower than before operation (P0.05), seventh days after the operation to the normal low value, fourteenth days after the operation was significantly lower than the normal low value (P0.05), the serum TSH after first days after a sexual decline, the third days after the operation was significantly higher than before the operation (P0.05), fifth days after the operation was higher than the normal value higher after the operation. Blood serum TT3, first days after FT3, first days after operation, third days after operation, first days after operation, and a gradual rise in fifth days after operation, and the serum level of FT3 was lower than that before operation (P0.05) at every time point after operation, and the serum TT4, FT4 after the operation was higher than that of preoperative (P0.05). After the operation, it descended to the normal low value fourteenth days after the operation, and the first days after the operation of serum TSH decreased obviously, obviously lower than that before operation (P0.05), and then increased gradually, at seventh days after the operation (P0.05), and fourteenth days after the operation. The serum of bilateral thyroid gland subtotal excision group was TT3, FT3 was gradually decreased after operation, seventh after operation. The day was lower than the preoperative (P0.05), lower than the normal reference value, and then increased gradually, and there was no significant difference between the fourteenth days after the operation (P0.05). Serum TT4, first days after the operation, first days after the operation increased, obviously higher than before (P0.05), then gradually decreased, fourteenth days after the operation (P0.05), serum TT4 dropped to the normal value of the low limit, serum, near the normal value of the low limit, serum, near the normal value of the low limit of serum, serum FT4 was lower than normal value, and the serum TSH decreased significantly after operation, which was obviously lower than before operation (P0.05), and then increased gradually. The seventh day after operation was significantly higher than that before operation (P0.05), higher than normal value. The serum TT3, FT3 after unilateral subtotal thyroidectomy group decreased after operation, and was significantly lower than before operation (P0.05) after operation (P0.05), and fourteenth days after the operation, The level of serum TT4 and FT4 increased first days after operation, which was significantly higher than before operation (P0.05), then decreased gradually, after seventh days obviously lower than before operation (P0.05), and then gradually increased, and there was no significant difference between 14 days after TT4 operation (P0.05) after the operation of serum TT4, and first days after TSH in serum decreased significantly, obviously lower than before (P0.05), and then gradually increased, seventh days obviously. It was higher than before the operation, and then decreased gradually, fourteenth days after the operation was still higher than the preoperative, but not higher than the normal value. Conclusion: thyroid hormone in different stages of thyroid surgery has a dynamic change, and the change trend is different. According to the different range of thyroidectomy, the change trend of thyroid hormone in the blood circulation in the early post operation is different, giving exogenous nail The initial time of the replacement therapy of adenoidectomy and TSH inhibition is different. The residual thyroid compensatory function is better after unilateral thyroidectomy, and a relatively small amount or no exogenous thyroid hormone replacement therapy can be given within one month after the operation; the residual thyroid compensatory function after bilateral thyroidectomy is poor. Exogenous thyroid hormone replacement therapy was given about 14 postoperatively, and exogenous thyroid hormones could be treated with TSH inhibition after fifth days after bilateral thyroidectomy, and exogenous thyroid hormones could be treated with TSH inhibition after fourteenth days after total resection of the affected thyroid and isthmus. All patients should develop individualized treatment based on thyroid hormone levels at the corresponding time.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R653

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