甲状腺切除术中保留甲状旁腺原位带蒂血管联合自体移植疗效
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摘要
目的探讨甲状腺手术中甲状旁腺原位带蒂血管保留及即刻自体移植的疗效。方法选择吉林省人民医院2017年1月至2019年1月收治且接受甲状腺切除术治疗的甲状腺癌患者200例作为研究对象,按照治疗方式不同分为对照组施行常规甲状腺切除术和研究组在甲状腺切除术中原位保留甲状旁腺带蒂血管,并即刻自体移植,各100例。比较两组患者的术后并发症发生率和甲状旁腺功能减退发生率;术后恢复时间、血钙、血磷、甲状旁腺激素水平和细胞免疫功能指标。结果术后研究组并发症和甲状旁腺功能减退发生率均低于对照组;研究组术后恢复时间均短于对照组,差异有统计学意义(P<0.05)。术后,两组血钙、血磷和甲状旁腺激素水平、CD3+和CD4/CD8均较手术前降低;但研究组的血钙、血磷、甲状旁腺激素水平、CD3+和CD4/CD8均高于对照组,差异有统计学意义(P<0.05)。结论在甲状腺手术中原位保留甲状旁腺带蒂血管,再进行即刻自体移植,可有效减轻手术对患者甲状旁腺功能的影响,有利于维持甲状旁腺功能。
Objective To investigate the effect of preservation of pedicled vessels in situ and immediate autotransplantation of parathyroid glands in thyroid surgery. Method 200 patients with thyroid cancer treated by thyroidectomy in Jilin Provincial People's Hospital from January 2017 to January 2019 were selected as study subjects.According to different treatment methods, the patients in the control group were divided into routine thyroidectomy group and the study group were treated with parathyroid pedicled vessels in situ preservation and immediate autotransplantation, 100 cases in each group. The incidence of complications and hypoparathyroidism, recovery time,serum calcium, phosphorus, parathyroid hormone levels and cellular immune function were compared between the two groups. Result The incidence of complications and hypoparathyroidism in the study group was lower than that in the control group, and the recovery time in the study group was shorter than that in the control group, with statistical significance(P<0.05). After operation, the levels of serum calcium, phosphorus, parathyroid hormone, CD3+ and CD4/CD8 in both groups were lower than those before operation, but the levels of serum calcium, phosphorus, parathyroid hormone, CD3+ and CD4/CD8 in the study group were higher than those in the control group, with significant difference(P<0.05). Conclusion The preservation of pedicled parathyroid vessels in situ and immediate autologous transplantation in thyroid surgery can effectively reduce the impact of surgery on thyroid function, which is conducive to maintain thyroid function.
Objective To investigate the effect of preservation of pedicled vessels in situ and immediate autotransplantation of parathyroid glands in thyroid surgery. Method 200 patients with thyroid cancer treated by thyroidectomy in Jilin Provincial People's Hospital from January 2017 to January 2019 were selected as study subjects.According to different treatment methods, the patients in the control group were divided into routine thyroidectomy group and the study group were treated with parathyroid pedicled vessels in situ preservation and immediate autotransplantation, 100 cases in each group. The incidence of complications and hypoparathyroidism, recovery time,serum calcium, phosphorus, parathyroid hormone levels and cellular immune function were compared between the two groups. Result The incidence of complications and hypoparathyroidism in the study group was lower than that in the control group, and the recovery time in the study group was shorter than that in the control group, with statistical significance(P<0.05). After operation, the levels of serum calcium, phosphorus, parathyroid hormone, CD3+ and CD4/CD8 in both groups were lower than those before operation, but the levels of serum calcium, phosphorus, parathyroid hormone, CD3+ and CD4/CD8 in the study group were higher than those in the control group, with significant difference(P<0.05). Conclusion The preservation of pedicled parathyroid vessels in situ and immediate autologous transplantation in thyroid surgery can effectively reduce the impact of surgery on thyroid function, which is conducive to maintain thyroid function.
引文
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[11]苏艳军,刘彬,刁畅,等.甲状腺术中甲状旁腺体外保存后自体移植对其功能影响的研究[J].重庆医学,201746(8):1032-1035.
[12]易国华,刘宜翔,朱洪波.全甲状旁腺切除术联合自体移植治疗尿毒症继发性甲状旁腺功能亢进症的临床分析[J].实用临床医药杂志,2018,22(11):91-94.
[13]王学智,闫文强,洪智攀,等.甲状腺术中甲状旁腺原位带蒂血管保留及即刻自体移植[J].内蒙古医学杂志2015,47(1):23-25.
[14]徐婷.甲状旁腺自体移植在全甲状腺切除术中的效果评价[D].青海省:青海大学,2015.
[15]李国庆,孙文聪,丁超,等.甲状旁腺原位保留与即刻主动自体移植术后甲状旁腺激素水平的比较[J].中华实验外科杂志,2019,36(4):734-736.
[2]赵宁,滕长胜.甲状腺癌手术中甲状旁腺的识别和保护[J].国际外科学杂志,2015,42(2):105-108,f3.
[3]Chu R,VanHasselt A,Vlantis A C,et al.The cross-talk between estrogen receptor and peroxisome proliferatoractivated receptor gamma in thyroid cancer[J].Cancer,2014120(1):142-153.
[4]陈峰,王瑞娟,游振辉,等.甲状腺全切除术中损伤甲状旁腺行自体移植的应用[J].中华实验外科杂志,201532(12):3144-3146.
[5]冯勇.甲状旁腺原位显露与保护在分化型甲状腺癌手术中的应用[D].天津:天津医科大学,2014.
[6]刘彬,程若川,苏艳军,等.甲状腺术中甲状旁腺原位损伤类型对甲状旁腺功能的影响[J].国际外科学杂志2016,43(5):309-312,f3.
[7]Lesnik D,Cunnane M E,Zurakowski D,et al.Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients[J].Head Neck,2014,36(2):191-202.
[8]李宗魁,姚思扬,梁斌,等.甲状旁腺全切除术并改良自体移植术治疗尿毒症继发甲状旁腺功能亢进的疗效观察[J].中国临床新医学,2019,12(1):35-38.
[9]Matsuzu K,Sugino K,Masudo K,et al.Thyroid lobectomy for papillary thyroid cancer:Long-term follow-up study of 1,088 cases[J].World J Surg,2014,38(1):68-79.
[10]司丽,张森,刘桂凌,等.甲状旁腺全切加自体移植在继发性甲状旁腺功能亢进患者中的疗效观察[J].肾脏病与透析肾移植杂志,2017,26(5):426-431.
[11]苏艳军,刘彬,刁畅,等.甲状腺术中甲状旁腺体外保存后自体移植对其功能影响的研究[J].重庆医学,201746(8):1032-1035.
[12]易国华,刘宜翔,朱洪波.全甲状旁腺切除术联合自体移植治疗尿毒症继发性甲状旁腺功能亢进症的临床分析[J].实用临床医药杂志,2018,22(11):91-94.
[13]王学智,闫文强,洪智攀,等.甲状腺术中甲状旁腺原位带蒂血管保留及即刻自体移植[J].内蒙古医学杂志2015,47(1):23-25.
[14]徐婷.甲状旁腺自体移植在全甲状腺切除术中的效果评价[D].青海省:青海大学,2015.
[15]李国庆,孙文聪,丁超,等.甲状旁腺原位保留与即刻主动自体移植术后甲状旁腺激素水平的比较[J].中华实验外科杂志,2019,36(4):734-736.