本文關鍵詞： 甲狀旁腺 自體移植 甲狀腺全切除術　出處：《青海大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:在全甲狀腺切除術中,對甲狀旁腺的原位保留及自體移植進行臨床觀察,為甲狀旁腺自體移植在臨床中有效應用提供理論依據(jù)。方法:收集青海大學附屬醫(yī)院乳腺甲狀腺外科在2013年3月至2014年12月期間行甲狀腺全切除術的患者70例,將他們分為觀察組和對照組,各35例。兩組均行甲狀腺全切除術:觀察組術中暴露并保護甲狀旁腺,對誤切或者瘀血變色血供不足者的旁腺移植于胸鎖乳突肌內;對照組不完全暴露甲狀旁腺,不作甲狀旁腺自體移植術。2組患者術前常規(guī)檢查Ca和PTH濃度,術后1d、3d、5d及1月檢測Ca和PTH濃度。術后觀察對比兩組患者發(fā)生甲狀旁腺功能減退和低鈣血癥的情況,判定移植后甲狀旁腺能否存活分泌甲狀旁腺激素。結果:(1)表3.1、表3.2表明兩組患者術前性別以及手術方式均無差異,P0.05。(2)表3.3表明兩組術后PTH變化,觀察組PTH升高趨勢明顯好于對照組,1月后兩組患者基本完全恢復,術后第1、3、5d無差異,1月后P0.05,差異有統(tǒng)計學意義。(3)表3.5中兩組病人術后第1d、第3d均出現(xiàn)低鈣血癥伴有程度不同的手腳、口周麻木感,第5d后觀察組低鈣癥狀消失,1月后,觀察組患者術后恢復較好,P0.05。(4)表3.7中出現(xiàn)暫時性低鈣血癥觀察組3(8.5%),對照組10(28.5%),P0.05。(5)表3.8中移植2、3枚甲狀旁腺,甲狀旁腺功能低下的發(fā)生率分別為14.2%、10.0%明顯低于移植1枚甲狀旁腺的發(fā)生率54.5%,P0.05差異有統(tǒng)計學意義。(6)術后出現(xiàn)低鈣癥狀的患者均予以口服或靜脈補鈣,大部分患者在術后5~7天癥狀消失,表3.4、表3.6表明患者術后1月比術前完全恢復,P0.05差異有統(tǒng)計學意義,無一例發(fā)生永久性甲狀旁腺功能低下。結論:甲狀旁腺自體移植大大降低了術后甲狀旁腺功能低下的發(fā)生率;移植的甲狀旁腺以2-3枚效果最好,移植時將甲狀旁腺盡可能切成小小的組織勻漿,這樣甲狀旁腺會更快恢復分泌功能;移植的甲狀旁腺在術后1個月內即可恢復分泌功能。
[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.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R653

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