Li J H, Chen X H
Department of Head and Neck Center of Southern Suburb Branch of Peking University Cancer Hospital, Beijing 102600, China.
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Mar 7;55(3):249-253. doi: 10.3760/cma.j.issn.1673-0860.2020.03.011.
To evaluate the effect of glucocorticoid used in perioperative period of total thyroidectomy (TT) plus central compartment lymph node dissection (CCLND) or combining with lateral neck dissection on postoperative hypoparathyroidism (HPT) and hypocalcemia (HPC). The data of 117 patients with papillary thyroid carcinoma (PTC) undergone the surgeries in Tongren Hospital between Nov 2015 and Mar 2017 were retrospectively analyzed. There were 36 males and 81 females, and their ages ranged from 21 to 74 years old, average age of 47.8±12.5. TT and CCLND were performed in 81 (69.2%) patients, and TT, CCLND and unilateral or bilateral lateral neck dissection were performed in 36 (30.8%) patients. The patients were divided into 4 groups: Group A (40 patients), no glucocorticoid was applied; Group B (36 patients), 5 mg dexmethasone sodium phosphate was sprayed on the surface of wound on both sides of trachea during operation; Group C (21 patients), 40 mg methylprednisolone was applied by intravenous injection after operation, one time per day for 3 days; Group D (20 patients), 5 mg dexmethasone sodium phosphate was sprayed on the surface of wound on both sides of trachea during operation and 40 mg methylprednisolone were applied by intravenous injection after operation, one time per day for 3 days. Serum parathyroid hormone and calcium were tested before operation and at the 1(st), 2(nd) and 3(rd) day after operation. Spss19.0 was used to analyze the data. There were statistically significant differences in the incidences of both no HPT and no HPC and the incidence of HPT alone between Group A and B (35.0% 61.1%, 15.0% 2.8%, χ(2) were 5.182 and 3.885, respectively, <0.05), but not in the incidence of HPC alone between the two groups. There were statistically significant difference in the incidences of both no HPT and no HPC between Group A and D (35% 70.0%, χ(2)=6.530, <0.05), but not in the incidences of HPT or HPC between the two groups. There were not statistically significant differences in the individual incidences between Groups A and C (>0.05). There were statistically significant differences in the incidence of both no HPT and no HPC and the incidence of HPT alone between Groups B and C (61.1% 23.8%, 2.8% 23.8%, χ(2) were 7.402 and 6.229, respectively, <0.05), but not in the incidence of HPC between the two groups (>0.05). HPT and HPC often occurred on the 1(st) or 2(nd) day after operation. Permanent hypocalcemia did not occur in all cases. Intraoperative especially plus post-operative application of glucocorticoid can decrease the incidence of HPT after operation.
评估糖皮质激素在全甲状腺切除术（TT）加中央区淋巴结清扫术（CCLND）围手术期使用，或联合侧颈清扫术对术后甲状旁腺功能减退症（HPT）和低钙血症（HPC）的影响。回顾性分析2015年11月至2017年3月在同仁医院接受手术的117例甲状腺乳头状癌（PTC）患者的数据。其中男性36例，女性81例，年龄21至74岁，平均年龄47.8±12.5岁。81例（69.2%）患者行TT和CCLND，36例（30.8%）患者行TT、CCLND及单侧或双侧侧颈清扫术。患者分为4组：A组（40例），未应用糖皮质激素；B组（36例），术中在气管两侧伤口表面喷洒5mg地塞米松磷酸钠；C组（21例），术后静脉注射40mg甲泼尼龙，每日1次，共3天；D组（20例），术中在气管两侧伤口表面喷洒5mg地塞米松磷酸钠，术后静脉注射40mg甲泼尼龙，每日1次，共3天。于术前及术后第1、2、3天检测血清甲状旁腺激素和血钙。采用Spss19.0软件进行数据分析。A组与B组在无HPT和无HPC发生率以及单独HPT发生率方面差异有统计学意义（35.0%对61.1%，15.0%对2.8%，χ²分别为5.182和3.885，均<0.05），但两组单独HPC发生率差异无统计学意义。A组与D组在无HPT和无HPC发生率方面差异有统计学意义（35%对70.0%，χ²=6.530，<0.05），但两组HPT或HPC发生率差异无统计学意义。A组与C组各发生率差异无统计学意义（>0.05）。B组与C组在无HPT和无HPC发生率以及单独HPT发生率方面差异有统计学意义（61.1%对23.8%，2.8%对23.8%，χ²分别为7.402和6.229，均<0.05），但两组HPC发生率差异无统计学意义（>0.05）。HPT和HPC多发生在术后第1或2天。所有病例均未发生永久性低钙血症。术中尤其是术后应用糖皮质激素可降低术后HPT的发生率。
