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目的:研究不同甲状腺手术方式,尤其是中央区淋巴结清扫的作用以及术后甲状旁腺功能减退的发生。方法:连续收集同组医师操作的100例甲状腺手术病例。按手术方式分为6组:单侧甲状腺切除组12例,单侧甲状腺切除加单侧中央区颈淋巴结清扫组13例,双侧甲状腺切除组7例,双侧甲状腺切除加单侧中央区颈淋巴结清扫组32例,双侧甲状腺切除加双侧中央区颈淋巴结清扫组24例,双侧甲状腺切除加双侧中央区及患侧颈侧区颈淋巴结清扫组12例。分析其治疗结果及并发症发生率,尤其是对甲状旁腺功能的影响。结果:100例中单纯甲状腺乳头状癌74例,其中p N136例(48.6%)。除单侧甲状腺切除术外,其他手术方式术后第1天甲状旁腺激素水平均明显下降,但多可在术后1个月恢复至正常范围。75例共出现41例暂时性和4例永久性甲状旁腺功能减退(甲旁减),其发生率分别为54.7%和5.3%。行双侧甲状腺切除术病例暂时性甲旁减发生率显著高于单侧术式组,但各组间永久性甲旁减发生率无统计学差异,通过适当口服钙剂和维生素D,病人均无明显低钙症状。结论:对甲状腺乳头状癌病人行中央区淋巴结清扫,有积极而肯定的意义。对甲状旁腺功能影响多为暂时。
Objective: To study the different thyroid surgery methods, especially the central lymph node dissection and postoperative parathyroid hypothyroidism. Methods: A total of 100 cases of thyroid surgery operated by the same group of doctors were collected. The patients were divided into 6 groups by surgery: 12 cases of unilateral thyroidectomy group, 13 cases of unilateral thyroidectomy plus unilateral cervical lymph node dissection group, 7 cases of bilateral thyroidectomy group, bilateral thyroidectomy plus unilateral central region neck Lymph node dissection in 32 cases, bilateral thyroidectomy plus bilateral central lymph node dissection group, 24 cases of bilateral thyroidectomy plus bilateral central and ipsilateral cervical lymph node dissection in 12 cases. Analysis of the treatment results and the incidence of complications, especially on the parathyroid function. Results: Of the 100 cases, there were 74 thyroid papillary carcinomas with p N136 cases (48.6%). In addition to unilateral thyroidectomy, other surgical methods on the first postoperative day parathyroid hormone levels were significantly decreased, but more than 1 month after surgery to return to normal range. Of the 75 patients, 41 were transient and 4 had permanent hypoparathyroidism (hypoparathyroidism), with rates of 54.7% and 5.3%, respectively. The incidence of temporary parathyroidectomy in patients undergoing bilateral thyroidectomy was significantly higher than that in unilateral surgery, but there was no significant difference in the incidence of permanent parathyroidectomy among the groups. With appropriate oral calcium and vitamin D, both patients No obvious hypocalcemia symptoms. Conclusion: There is a positive and positive meaning for the central lymph node dissection in patients with thyroid papillary carcinoma. Impact on parathyroid function and more for the time being.