甲状腺全切术后6个月低钙血症的风险因素分析  

Risk factors for hypocalcemia 6months after total thyroidectomy

作　　者：安宁[1] 张建伟[1] 王军[1] 满国栋[1] 张宏[1] 王娟[1] An Ning;Zhang Jianwei;Wang Jun;Man Guodong;Zhang Hong;Wang Juan(Department of Head and Neck Surgery,Gansu Povincial Tumor Hospital,Lcwzhou,Gansu,730050,China)

机构地区：[1]甘肃省肿瘤医院头颈二科,甘肃兰州730050

出　　处：《中国医学文摘（耳鼻咽喉科学）》2021年第1期25-29,共5页Chinese Medical Digest(Otorhinolaryngology)

基　　金：甘肃省卫生行业科研计划项目(项目编号:GSWSKY2017-13)。

摘　　要：目的探讨甲状腺全切术后6个月低钙血症发生的风险因素。方法前瞻性选取87例于2019年3月~2020年2月在我科行甲状腺全切的甲状腺癌患者,除未分化癌及滤泡癌各1例外,均为甲状腺乳头状癌。其中甲状腺被膜侵犯27例,17例合并桥本。初治患者85例,补充全切患者2例。单侧中央区清扫40例,双侧中央区清扫47例,单侧侧颈清扫27例,双侧侧颈清扫3例。术前测量患者血钙、甲状旁腺激素(parathyroid hormone,PTH),术后分别测量第1、3、5天及术后1月、6个月的血钙、PTH值。结果术后6个月血钙>2.0 mmol/L未达到正常者30例。单因素分析中术中甲状旁腺移植、术后不同时点PTH水平显示统计学差异。多因素分析显示:只有甲状旁腺移植和术后第3天PTH为独立预测因素。ROC曲线进一步显示:第3天PTH诊断阈值低于12.61 ng/L时,预测术后6个月亚临床低钙血症的敏感度63.3%,特异度71.9%。结论甲状旁腺自体移植可以减少术后6个月的低钙发生率。术后测量PTH值有助于预测术后6个月低血钙的发生,其中术后第3天PTH值最具价值。Objective To investgate risk factors realted to hypocalcemia 6months after total thyroidectomy.Methods From March 2019 to February 2020,87 patients with thyroid cancer underwent total thyroidectomy were prospectively selected.They are all papillary thyroid carcinoma except 1 case of undifferentiated carcinoma and 1 case follicular carcinoma.There were 16 males and 71 females,with an average age of(43.9±10.8)years,a mean maximum diameter of(1.2±0.54)cm,27 cases of thyroid capsule invasion,and 17 cases with Hashimoto’s thyroiditis.There were 40 cases of unilateral level Ⅵ dissection,47 cases of bilaterally,27 cases of unilateral lateral neck dissection and 3 cases of bilaterally.The serum calcium and parathyroid hormone(PTH)were measured preoperation,1,3,5 days and 1,6 months post-operation.Results 6 months after operation,30 patients with serum calcium above 2.0 but lower than 2.25 mmol / L were found.Univariate analysis showed that parathyroid autotransplantation and serum PTH value at different time points were related to hypocalcemia 6-months postoperation.Multivariate analysis further showed that the PTH value on the third day after operation and parathyroid autotransplantation was the only independent risk factor.According to ROC curve,day3 PTH(parathyroid hormone)threshold value was 12.61 ng/L,operation,the sensitivity and specificity of predicting hypocalcemia were 63.3% and 71.9%,respectively.Conclusion Parathyroid autotransplantation can reduce the incidence of hypocalcemia 6 months after operation.The measurement of PTH after operation is helpful to predict the occurrence of hypocalcemia in 6 months,and the value of PTH on the third day is the most valuable.

关 键 词：甲状腺肿瘤 甲状腺切除术 低钙血症 甲状旁腺功能减退症 

分 类 号：R73[医药卫生—肿瘤]