Zhou Jian, Ju Hongqing, Ma Hongyan, Diao Qixian
Second Department of General Surgery, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Haici Hospital), Qingdao, China.
Operating Room of Qingdao Traditional Chinese Medicine Hospital (Qingdao Haici Hospital), Qingdao, China.
Front Surg. 2022 May 27;9:905920. doi: 10.3389/fsurg.2022.905920. eCollection 2022.
Analyze the clinical effect of modified small incision thyroidectomy and evaluate the influencing factors of hypocalcemia (EH) in patients after operation.
A total of 220 patients with thyroid cancer in our hospital from October 2019 to October 2021 were selected. The patients were randomly divided into a control group and an observation group, with 110 patients in each group. The control group were treated with traditional thyroidectomy, while the observation group were treated with modified small incision surgery. The perioperative indicators of the two groups were compared. The thyroid hormone indexes of the two groups were meansured before operation and 7 days after operation, and the incidence of complications was compared between the two groups. Serum calcium was detected 7 days after operation in both groups. According to the level of blood calcium, patients were divided into EH group and normal group. The data of two groups were compared, and the related factors affecting the occurrence of EH after operation were analyzed.
The operation time, incision length and intraoperative bleeding volume of patients in the observation group were significantly lower than those of patients in the control group (< 0.05). There was no significant difference in drainage time and postoperative drainage volume between the two groups (> 0.05). The postoperative PTH level of patients in the observation group was significantly higher than that in the control group (< 0.05), but there was no significant difference in FT3, FT4 and TSH levels (> 0.05). The incidence of postoperative complications in the observation group (11.82%) was significantly lower than that in the control group (34.55%). Logistic regression analysis showed that bilateral lymph node dissection, parathyroidectomy and decreased PTH were the independent risk factors for EH in our patient after operation (< 0.05).
The modified small incision operation can effectively reduce the occurrence of surgical trauma and related complications. Bilateral lymph node dissection, parathyroidectomy and PTH decrease are the risk factors for postoperative EH in patients with thyroid cancer. Taking corresponding measures to improve the metabolic function of patients during perioperative period will help to reduce the incidence of postoperative EH in patients with thyroid cancer.
分析改良小切口甲状腺切除术的临床效果，评估术后患者低钙血症（EH）的影响因素。
选取2019年10月至2021年10月我院收治的220例甲状腺癌患者。将患者随机分为对照组和观察组，每组110例。对照组采用传统甲状腺切除术治疗，观察组采用改良小切口手术治疗。比较两组围手术期指标。分别于术前及术后7天测定两组患者的甲状腺激素指标，并比较两组并发症发生率。两组均于术后7天检测血清钙。根据血钙水平将患者分为EH组和正常组。比较两组数据，分析影响术后EH发生的相关因素。
观察组患者的手术时间、切口长度及术中出血量均显著低于对照组（<0.05）。两组患者的引流时间及术后引流量比较，差异无统计学意义（>0.05）。观察组患者术后甲状旁腺激素（PTH）水平显著高于对照组（<0.05），但游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）及促甲状腺激素（TSH）水平比较，差异无统计学意义（>0.05）。观察组术后并发症发生率（11.82%）显著低于对照组（34.55%）。Logistic回归分析显示，双侧淋巴结清扫、甲状旁腺切除术及PTH降低是本研究患者术后发生EH的独立危险因素（<0.05）。
改良小切口手术可有效减少手术创伤及相关并发症的发生。双侧淋巴结清扫、甲状旁腺切除术及PTH降低是甲状腺癌患者术后发生EH的危险因素。围手术期采取相应措施改善患者代谢功能，有助于降低甲状腺癌患者术后EH的发生率。
