甲状旁腺自体移植在全甲状腺切除术中的效果评价

发布时间：2018-02-02 08:33

本文关键词： 甲状旁腺自体移植甲状腺全切除术　出处：《青海大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:在全甲状腺切除术中,对甲状旁腺的原位保留及自体移植进行临床观察,为甲状旁腺自体移植在临床中有效应用提供理论依据。方法:收集青海大学附属医院乳腺甲状腺外科在2013年3月至2014年12月期间行甲状腺全切除术的患者70例,将他们分为观察组和对照组,各35例。两组均行甲状腺全切除术:观察组术中暴露并保护甲状旁腺,对误切或者瘀血变色血供不足者的旁腺移植于胸锁乳突肌内;对照组不完全暴露甲状旁腺,不作甲状旁腺自体移植术。2组患者术前常规检查Ca和PTH浓度,术后1d、3d、5d及1月检测Ca和PTH浓度。术后观察对比两组患者发生甲状旁腺功能减退和低钙血症的情况,判定移植后甲状旁腺能否存活分泌甲状旁腺激素。结果:(1)表3.1、表3.2表明两组患者术前性别以及手术方式均无差异,P0.05。(2)表3.3表明两组术后PTH变化,观察组PTH升高趋势明显好于对照组,1月后两组患者基本完全恢复,术后第1、3、5d无差异,1月后P0.05,差异有统计学意义。(3)表3.5中两组病人术后第1d、第3d均出现低钙血症伴有程度不同的手脚、口周麻木感,第5d后观察组低钙症状消失,1月后,观察组患者术后恢复较好,P0.05。(4)表3.7中出现暂时性低钙血症观察组3(8.5%),对照组10(28.5%),P0.05。(5)表3.8中移植2、3枚甲状旁腺,甲状旁腺功能低下的发生率分别为14.2%、10.0%明显低于移植1枚甲状旁腺的发生率54.5%,P0.05差异有统计学意义。(6)术后出现低钙症状的患者均予以口服或静脉补钙,大部分患者在术后5~7天症状消失,表3.4、表3.6表明患者术后1月比术前完全恢复,P0.05差异有统计学意义,无一例发生永久性甲状旁腺功能低下。结论:甲状旁腺自体移植大大降低了术后甲状旁腺功能低下的发生率;移植的甲状旁腺以2-3枚效果最好,移植时将甲状旁腺尽可能切成小小的组织匀浆,这样甲状旁腺会更快恢复分泌功能;移植的甲状旁腺在术后1个月内即可恢复分泌功能。
[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.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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