甲状腺切除术后病人并发甲状旁腺功能减退的危险因素分析  

Analysis of risk factors for hypoparathyroidism in patients after thyroidectomy

作　　者：郭颖 徐慧婕 郑蕾[1] 张世瑜[1] 雷铭 严佶琪[1] 陈曦[1] 杨卫平[1] GUO Ying;XU Huijie;ZHENG Lei;ZHANG Shiyu;LEI Ming;YAN Jiqi;CHEN Xi;YANG Weiping(Department of Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Surgery,Minhang District Central Hospital Shanghai,Shanghai 201199,China)

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025 [2]上海市闵行区中心医院外科,上海201199

出　　处：《外科理论与实践》2020年第6期507-511,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:分析甲状腺切除术后病人并发甲状旁腺功能减退的危险因素。方法:选取2018年5月至2018年7月,上海交通大学医学院附属瑞金医院外科118例甲状腺切除术病人的临床资料,收集手术前、后血清甲状旁腺素(PTH)含量。通过多因素Logisitic回归分析术后并发甲状旁腺功能减退的危险因素。结果:病人术后甲状旁腺功能减退发生率为17.80%,其中2例发生永久性甲状旁腺功能减退,其术前和术后1 d、180 d PTH分别为0.049 6、0.008 2和0.013 8 pg/L,19例暂时性甲状旁腺功能减退病人相应PTH分别为0.047 9、0.021 7和0.033 2 pg/L。单因素分析显示,年龄、性别、体质量指数、合并高血压、吸烟、饮酒、肿瘤病理类型与甲状旁腺功能减退的发生无相关性(P>0.05)。肿瘤N1分期、合并桥本甲状腺炎、淋巴结清扫、甲状旁腺误切、未应用纳米炭示踪剂以及肿瘤直径与甲状旁腺功能减退的发生相关(P<0.05)。多因素分析显示合并桥本甲状腺炎、肿瘤N1分期、肿瘤直径≥4 cm、淋巴结清扫、甲状旁腺误切、未应用纳米炭示踪剂是甲状旁腺功能减退发生的独立危险因素。结论:甲状腺切除术后病人并发甲状旁腺功能减退与肿瘤N1分期、合并桥本甲状腺炎、肿瘤直径≥4 cm、淋巴结清扫、甲状旁腺误切、未应用纳米炭示踪剂相关,是甲状旁腺功能减退的危险因素。Objective To analyze the risk factors associated with hypoparathyroidism(HP) after thyroidectomy.Methods The clinical data of 118 patients with thyroidectomy were reviewed in Ruijin Hospital including parathyroid hormone(PTH) in serum before and after surgery from May 2018 to July 2018. Risk factors associated with postoperative HP were analyzed by multivariate Logistic regression models. Results The incidence of postoperative HP in this study was17.80% including 2 cases with permanent HP. PTH in serum of 2 cases with permanent HP was 0.049 6 pg/L, 0.008 2 pg/L,0.013 8 pg/L and those of 19 cases with temporary HP was 0.047 9 pg/L, 0.021 7 pg/L, 0.033 2 pg/L preoperative, postoperative 1 d and 180 d later respectively. Univariate analysis showed that HP was related with tumor N1 stage, Hashimoto thyroiditis, lymph node dissection, parathyroidectomy, without use of nano-carbon tracer and tumor diameter(P <0.05).However, HP was not related with gender, age, body mass index, hypertension, smoking, drinking, and pathological type(P>0.05). It was shown by multivariate analysis that Hashimoto thyroiditis, tumor N1 stage, tumor diameter 4 cm and more,lymph node dissection, parathyroidectomy, without use of nano-carbon tracer were independent risk factors for HP. Conclusions The patients with HP after total thyroidectomy were associated with tumor N1 stage, Hashimoto thyroiditis, tumor diameter 4 cm and more, lymphatic dissection, parathyroidectomy, and without use of nano-carbon tracer which would be the risk factors of HP.

关 键 词：甲状腺切除 甲状旁腺功能减退 危险因素 

分 类 号：R653[医药卫生—外科学]