發(fā)布時間：2018-11-21 10:01

【摘要】：目的甲狀腺乳頭狀癌行傳統(tǒng)全甲狀腺切除術(shù)后常見并發(fā)癥為甲狀旁腺功能低下,可引起嚴(yán)重低鈣,患者極為痛苦,且無有效替代藥物,極易引起醫(yī)療糾紛。本研究探討改良Miccoli手術(shù)在全甲狀腺切除中的安全性,從而有效保護(hù)甲狀旁腺。方法回顧性分析2010-07-03-2015-07-19勝利油田中心醫(yī)院乳腺甲狀腺外科144例全甲狀腺切除的甲狀腺乳頭狀癌患者臨床資料,根據(jù)治療方法分成納米碳組(A組)31例、改良Miccoli組(B組)71例和傳統(tǒng)手術(shù)組(C組)42例,分析比較3組患者術(shù)后的甲狀旁腺激素水平。結(jié)果A、B、C 3組患者術(shù)后第1天甲狀旁腺激素水平分別為(7.85±2.45)、(5.39±2.15)和(4.50±1.83)pg/mL,3組之間差異均有統(tǒng)計學(xué)意義,F=23.123,P=0.001(A、B兩組t=5.092,P0.001;A、C兩組t=6.697,P0.001;B、C兩組t=2.223,P=0.028);A、B、C 3組患者術(shù)后第7天甲狀旁腺激素水平分別為(9.61±3.32)、(8.68±2.83)和(7.50±1.90)pg/mL;術(shù)后1個月甲狀旁腺激素水平分別為(22.27±6.45)、(21.24±5.01)和(12.16±4.52)pg/mL。其中A、B兩組術(shù)后7d(t=1.449,P=0.150)及術(shù)后1個月(t=0.793,P=0.432)甲狀旁腺激素水平差異均無統(tǒng)計學(xué)意義,C組甲狀腺旁腺激素水平明顯低于A、B兩組,與該兩組相比術(shù)后7d及術(shù)后1個月甲狀旁腺激素水平差異均有統(tǒng)計學(xué)意義,(術(shù)后第7天C、A兩組t=0.197,P=0.003;C、B兩組t=2.403,P=0.018;術(shù)后1個月C、A兩組t=7.748,P0.001,C、B兩組t=9.654,P0.001)。結(jié)論在全甲狀腺切除時,改良Miccoli手術(shù)與納米碳治療效果相當(dāng),能安全有效的保護(hù)甲狀旁腺,對于納米碳顯影不佳的部分患者,改良Miccoli手術(shù)可提供另外一種安全、有效的治療方式。
[Abstract]:Objective the common complication after traditional total thyroidectomy for papillary thyroid carcinoma is hypoparathyroidism, which can cause severe hypocalcemia, severe pain, and no effective substitute drugs, so it is easy to cause medical disputes. The purpose of this study was to investigate the safety of modified Miccoli operation in total thyroidectomy and to protect parathyroid gland effectively. Methods the clinical data of 144 patients with papillary thyroid carcinoma undergoing total thyroidectomy in Shengli Oilfield Central Hospital 2010-07-03-2015-07-19 were retrospectively analyzed. The parathyroid hormone levels in modified Miccoli group (group B) and traditional operation group (group C) were analyzed and compared. Results the levels of parathyroid hormone in group C _ 3 were (7.85 鹵2.45), (鹵5.39 鹵2.15) and (4.50 鹵1.83) pg/mL,3, respectively. P0. 001 (t0. 092, P 0. 001); Group A C, group T 6.697, P 0.001, group C, t = 2.223, P = 0.028); The levels of parathyroid hormone were (9.61 鹵3.32), () 8.68 鹵2.83), (and (7.50 鹵1.90) pg/mL; on the 7th day after operation. The levels of parathyroid hormone were (22.27 鹵6.45), (21.24 鹵5.01) and (12.16 鹵4.52) pg/mL. 1 month after operation, respectively. There was no significant difference in parathyroid hormone levels between group A and group A on the 7th day (t = 1.449) and 1 month after operation (t = 0.793P ~ (0.432), but the level of parathyroid gland in group C was significantly lower than that in group A (n = 1), and the level of parathyroid hormone in group C was significantly lower than that in group A (n = 1). There were significant differences in parathyroid hormone levels between the two groups on the 7th day after operation and 1 month after operation. The patients in group C were treated with CU B and group C were 2.403 and 0.018 respectively, and the two groups with Con A and C were 7.748 and 0.001 respectively at one month after operation (t = 9.654, P 0.001). Conclusion in total thyroidectomy, the modified Miccoli procedure has the same effect as that of nano-carbon therapy and can protect parathyroid gland safely and effectively. The modified Miccoli procedure can provide another kind of safety for some patients with poor nano-carbon development. Effective treatment.
【作者單位】： 勝利油田中心醫(yī)院乳腺甲狀腺外科;
【基金】：吳階平醫(yī)學(xué)基金會臨床科研專項資助基金(320.6750.13235)
【分類號】：R736.1

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