甲状腺癌患者甲状腺全切除后甲状旁腺功能减退症的临床病理特征和危险因素  

Clinicopathological characteristics and predisposing risk factors of hypoparathyroidism after total thyroidectomy for thyroid cancer

作　　者：郑建伟[1] 宋慧敏[1] 蔡淑艳[1] 王云雷[1] 韩晓风[1] 吴浩良[1] 高志刚[1] 邱繁荣[1] Zheng Jianwei Song Huimin Cai Shuyan Wang Yunlei Han Xiaofeng Wu Haoliang Gao Zhigang Qiu Fanrong(Department of General Surgery, Jingxi Campus of Beijing Chaoyang Hospital,Capital Medical University, Beijing 100043, China)

机构地区：[1]首都医科大学附属北京朝阳医院西院普外科,北京100043

出　　处：《中华普通外科杂志》2016年第12期997-1000,共4页Chinese Journal of General Surgery

摘　　要：目的分析甲状腺癌患者行甲状腺全切除术后发生甲状旁腺功能减退的临床病理特征和危险因素。方法回顾性分析2003年7月至2015年12月期间在北京朝阳医院诊断为甲状腺癌且行甲状腺全切除附加或不附加中央区淋巴结清扫的539例患者资料。采用x2检验、Logistic回归分析筛选术后发生甲状旁腺功能减退的危险因素。结果539例患者中，术后甲状旁腺功能减退发生率25．6％（138／539）；其中暂时性21．9％（118／539）；永久性3．7％（20／539）。单因素分析显示，年龄〈45岁、肿瘤大小≥1．5cm、淋巴结转移、甲状旁腺移植、甲状腺全切除加双侧中央区淋巴结清扫、改良根治术、意外甲状旁腺切除、术后第1天iPTH水平≤5．8pg/ml等均为甲状旁腺功能减退的危险因素（均P〈0．05）。多因素分析显示，甲状旁腺移植（OR=1．890，95％C1：1．297～2．754．P=0．001）、甲状腺全切除加双侧中央区淋巴结清扫（OR=2．185，95％ CI：1．475～3．237．P〈0．001）、术中意外切下甲状旁腺（OR=2．831，95％CI：1．402～3．191，P〈0．001）、术后第1天iPTH≤5．8pg／ml（OR=2．323，95％ CI：1．588～3．399，P〈0．001）是术后发生甲状旁腺功能减退的独立危险因素。结论甲状腺全切除加双侧中央区淋巴结清扫术后更易出现甲状旁腺功能减退。Objective To evaluate clinieopathological characteristics and predisposing risk factors of postoperative hypoparathyroidism after total thyroidectomy for thyroid cancer. Methods This is a retrospective analysis on 539 consecutive total thyroidectomy cases with or without central compartment lymph node dissection for thyroid cancer operated from July 2003 to December 2015. The clinical and pathological features that related to postoperative hypoparathyroidism were studied by X2 test and multivariate Logistic regression analysis. Results Among the 539 patients, postoperative hypoparathyroidism occurred in 138 patients （25.6%）. Univariate analysis found the following risk factors： age 〈 45 years, tumor size ≥ 1.5 cm, lymph node metastasis, parathyroid autotransplantation, total thyroidectomy plus bilateral central compartment lymph node dissection, thyroidectomy combined modified radical neck dissection, incidental parathyroidectomy, iPTH levels ≤5.8 pg/ml on postoperative day 1 （all P 〈 0. 05 ）. Multivariate analysis showed that parathyroid autotransplantation （ OR = 1. 890, 95% CI： 1. 297 - 2. 754, P = 0. 001 ）, total thyroidectomy plus bilateral central compartment lymph node dissection （ OR = 2. 185, 95% CI： 1. 475 - 3. 237, P 〈0. 001）, incidental parathyroidectomy （ OR = 2. 831, 95% CI： 1. 402 - 3. 191, P 〈 0. 001 ） , iPTH levels≤5.8 pg/ml on postoperative day 1 （ OR =2. 323, 95% CI： 1. 588 -3. 399, P 〈0. 001 ） were independent risk factors. Conclusions Total thyroidectomy plus bilateral central compartment lymph node dissection was associated with an increased risk for postoperative hypoparathyroidism in patients with thyroid cancer.

关 键 词：甲状腺切除术 甲状旁腺功能减退症 甲状腺肿瘤 中央区淋巴结清扫 危险因素 

分 类 号：R736.1[医药卫生—肿瘤] R582.2[医药卫生—临床医学]