| Objective:The technique of protecting parathyroid was usually used during the operation at present in clinical practice,including under looking and Nanometer carbon tracer technology as well as Endoscopic technique identifying and protecting parathyroid,the three kinds of technology of identifying and protecting parathyroid during the operation compare with each other during respectively,and combining with the incidence rate of temporary hypocalcemia postoperation,the speed of recovery in patients of each group with hypocalcemia as well as the operation method impact on the recovery of hypocalcemia forward.Combing advantages and disadvantages of various methods and economic factors to evaluate the clinical value of what kind of method is higher.For the intraoperative protection of parathyroid provide evidence of the selection of method.Methods:Collected 305 cases which come from March 2013 to January 2015 and was done the surgery of thyroidectomy and central lymph node dissection by the same surgeon in our department.The pathologic type of the patients is differentiated thyroid carcinoma.The serum calcium and PTH in selected patients were normal before operation.In the selecting patients,200 cases of which were identifying and protecting parathyroid under looking during the operation and 50 cases of which were identifying and protecting parathyroid by Nanometer carbon tracer technique,55 cases of which were by Endoscopic technique.And parts of unclear organization were diagnosed by quick frozen histopathology,proved to be parathyroid.The parathyroid tissue was not be found in the postoperative pathology of all patients.Observing and recording the patients of hypocalcemia 3 hours,the first day,the third day,the fifth day,the seventh day and one month after operation and at the same time observing the recovery of hypocalcemia the first day,the third day,the fifth day,the seventh day and one month after operation.All cases were not using calcium proactively after operation.When testing for low serum calcium,the patients are supplied to calcium. Analysing the data about the hypocalcemia and recovery after operation of different ways and using chi-square test,All results were analysed using SPSS13.0 and the inspection level is 0.05. When comparing two hypothesis testing to ensure Ⅰ type mistake of the total probability remains the same, refine the comparing inspection level of 0.017.Combing the conclusions with other factors to evaluate which way of protecting and identifying parathyroid is more simple,easier,economic and high reliable,worthing to promote in the clinical.Results:1 Among the 200 cases that were protected under looking during the operation,106 cases were detected to be hypocalcemia and 50 cases that were protected by Nanometer carbon tracer,15 cases were hypocalcemia and 55 cases that were protected by Endoscopic technique,5 cases were found hypocalcemia 3 hours after operation.The incidence rates of hypocalcemia in tree groups was respectively 53.00%(106/200),30.00%(15/50),9.09%(5/55). The three incidence rates are not completely the same(?2=37.459,P<0.005) and were compared with each other to be statistically significant among the three groups(?2=8.473,P<0.005 and ?2=33.834,P<0.005 and ?2=7.426,P<0.01).2 8 cases have became normal in 106 cases of hypocalcemia in under looking group,2 cases have become normal in 15 cases of hypocalcemia in Nanometer carbon tracer group,1 case have became normal in 5 cases of hypocalcemia in Endoscopic group the first day after operation.The recovery rates of hypocalcemia in three groups were respectively 7.55%(8/106),13.33%(2/15),20%(1/5).The three incidence rates are all the same(?2=1.382,P>0.05).3 30 cases have became normal in 106 cases of hypocalcemia in under looking group,6 cases have become normal in 15 cases of hypocalcemia in Nanometer carbon tracer group,all of 5 cases of hypocalcemia have become normal in Endoscopic group the third day after operation.The recovery rate of hypocalcemia in three groups are 28.30%(30/106), 40.00%(6/15),100%(5/5). The three recovery rates are not completely the same(?2=11.613,P<0.005) and were compared with each other.The comparison between under looking group and Nanometer carbon tracer group is no statistically significant(?2=0.860,P>0.05).The other comparisons of between under looking group and Endoscopic group as well as Nanometer carbon tracer group and Endoscopic group were to be statistically significant(?2=8.291,P <0.005,Fisher’s exact probabilities,P=0.008).4 43 cases have became normal in 106 cases of hypocalcemia in under looking group,13 cases have became normal in 15 cases of hypocalcemia in Nanometer carbon tracer,patients in Endoscopic group have became normal already in the fifth day after operation.The recovery rate of hypocalcemia in three groups are respectively 40.57%(43/106),86.67%(13/15),100%(5/5).The three incidence rates are not completely the same(?2=16.730,P<0.005) and were compared with each other among the three groups.The results show that comparison between under looking group and Nanometer carbon tracer group as well as under looking group and Endoscopic group are statistically significant(?2=11.233,P < 0.005 and ?2=6.872,P < 0.01).The comparison between Nanometer carbon tracer group and Endoscopic group is no statistically significant(Fisher’s exact probabilities,P=0.447).5 The seventh day after operation,there is 3 cases of hypocalcemia has not been recovered in the under looking group and only one case in Nanometer carbon tracer group.The patients of hypocalcemia are all recovered in Endoscopic group.The recovery rates of the three groups are respectively 97.16%(103/106),93.33%(14/15),100%(5/5),the differences of which is no statistically significant(?2=0.800,P>0.05).6 Through the review after one month,there are 2 cases of hypocalcemia in the under looking group and one case in the Nanometer carbon tracer group have not been recovered who are permanent hypocalcemia.Patients of Endoscopic group are all recovered.The recovery rate of the three groups are 98.11%(104/106),93.33%(14/15),100%(5/5),the difference is no statistically significant(?2=1.419,P>0.05).Conclusions:1 It has the lowest possibility to be hypocalcemia postoperative using Endoscopic technique during operation,the second is the Nanometer carbon tracer technique.Under looking technique is the highest possible to be hypocalcemia postoperative.2 All patients with hypocalcemia can recover by supplying calcium to the hypocalcemia after operation within 3 days using Endoscopic technique to protect and identify the parathyroid,5 days using Nanometer carbon tracer technique,under looking needs 7 days to recover completely.Namely hypocalcemia recover within the shortest time,the second is Nanometer carbon tracer technique,under looking within the longest time.3 After one month,there are two cases have not been recovered in the under looking group and only one case has not been recovered in the Nanometer carbon tracer group who are permanent hypocalcemia.The recovery rates of hypocalcemia by the three kinds of operation are all the same.That is to say the long-term curative affection of the three kinds of operation on hypocalcemia is all the same.It has a high reference value and promoting significant to conduct how to choose the way of operation in clinic combining with other factors. |
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