术前钙剂和 VD ₃ 补充在中间入路喉返神经暴露甲状腺全切手术中的应用

Effect of preoperative Calcium and VD ₃ supplementation combined with intermediate approach of recurrent laryngeal nerve exposure for total thyroidectomy surgery

摘要

目的：探讨术前钙剂和维生素D ₃（VD ₃）补充联合中间入路喉返神经暴露甲状腺全切手术在甲状腺癌治疗中的价值。方法：选取2022年1月—2024年1月河北中石油中心医院收治的甲状腺癌患者114例，采用信封法将患者分为观察组（n=57）和对照组（n=57），两组均行中间入路喉返神经暴露甲状腺全切手术，其中观察组术前给予钙剂和VD ₃补充，对照组术后给予钙剂和VD ₃补充，观察两组手术指标、低钙血症发生情况及甲状腺功能、创伤应激反应指标水平的差异。结果：手术时间、术中出血量、术后引流量和住院时间比较，观察组与对照组差异无统计学意义（P>0.05）。观察组低钙血症发生率为0，低于对照组（12.28%，P<0.05）。观察组术后1 d血钙水平为（2.29±0.22）mmol/L，高于对照组的（2.20±0.21）mmol/L（P<0.05）；术前、术后3 d血钙水平比较，观察组与对照组差异无统计学意义（P>0.05）。观察组与对照组术前、术后1 d和术后3 d甲状旁腺激素（PTH）、皮质醇（Cor）、去甲肾上腺素（NE）比较差异无统计学意义（P>0.05）。结论：术前钙剂和VD ₃补充联合中间入路喉返神经暴露甲状腺全切手术有利于降低甲状腺癌术后低钙血症的发生，改善血钙水平，但对术后甲状腺功能、创伤应激反应无明显影响。

Abstract

Objective: To explore the value of preoperative calcium supplements and vitamin D ₃ (VD ₃) supplementation combined with intermediate approach recurrent laryngeal nerve exposure for total thyroidectomy in the treatment of thyroid cancer. Methods: A total of 114 thyroid cancer patients treated at the Hebei Petro China Center Hospital from January 2022 to January 2024 were selected. The envelope method was used, the patients were randomly divided into an observation group (n=57) and a control group (n=57). Both groups underwent total thyroidectomy with recurrent laryngeal nerve exposure via the midline approach. The observation group received calcium and vitamin D ₃ supplementation preoperatively, while the control group received calcium and vitamin D ₃ supplementation postoperatively. The differences in surgical indicators, hypocalcemia incidence, thyroid function, and trauma stress response indicators were observed between the two groups. Results: There was no statistically significant difference between the observation group and the control group in terms of surgical time, intraoperative blood loss, postoperative drainage volume, and hospital stay (P>0.05). The incidence of hypocalcemia in the observation group was 0, which was lower than that in the control group (12.28%, P<0.05). The postoperative blood calcium level postoperative 1 day in the observation group was (2.29±0.22) mmol/L, which was higher than that in the control group [(2.20±0.21) mmol/L,P<0.05]. There was no statistically significant difference in preoperative and postoperative blood calcium levels between the observation group and the control group (P>0.05). There was no statistically significant difference in parathyroid hormone, cortisol, norepinephrine levels between the observation group and the control group before surgery, 1 day after surgery, and 3 days after surgery (P>0.05). Conclusion: Preoperative calcium supplements and VD ₃ supplementation combined with intermediate approach exposure of the recurrent laryngeal nerve for total thyroidectomy surgery are beneficial in reducing the occurrence of postoperative hypocalcemia and improving blood calcium levels, but have no significant effect on postoperative thyroid function and traumatic stress response.

关键词

钙剂 / 维生素D₃ / 甲状腺全切手术 / 甲状腺肿瘤

Key words

Calcium agents / Vitamin D₃ / Total thyroidectomy surgery / Thyroid tumor

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基金资助

河北省廊坊市科学技术研究与发展计划项目(2021013153)