甲状腺全切除术后甲状旁腺激素水平变化的相关因素分析  

Analysis of changes of parathyroid hormone during different times following total thyroidectomy

作　　者：王松[1] 张方洁 代文杰[3] 敖亚洲[1] 柴吉鑫[1] 陈泳[1] 李波[1] WANG Song;ZHANG Fangjie;DAI Wenjie;AO Yazhou;CHAI Jixin;CHEN Yong;LI Bo(Department of Thyroid,the Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China;Department of Infectious Diseases,the Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China;Department of Thyroid,the First Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150000,China)

机构地区：[1]承德医学院附属医院甲状腺外科,河北承德067000 [2]承德医学院附属医院感染科,河北承德067000 [3]哈尔滨医科大学附属第一医院甲状腺外科,黑龙江哈尔滨150000

出　　处：《现代肿瘤医学》2022年第12期2150-2156,共7页Journal of Modern Oncology

基　　金：河北省承德市科学技术研究与发展计划项目(编号:201801A024)。

摘　　要：目的:探讨甲状腺全切术后甲状旁腺激素(parathyroid hormon,PTH)水平发生变化的相关影响因素及变化趋势,从而指导临床治疗。方法:回顾性分析2015年7月至2017年7月于我院甲状腺外科行甲状腺全切除术的180例病人资料,术后均给予预防性补钙,术后24小时均复查PTH、血钙,术后1、6个月随访血PTH及血钙水平。对所有病人的临床资料进行数据分析。结果:术后24小时、术后1个月的甲状旁腺功能减退发生率分别为32.20%、19.40%,6个月后甲状旁腺功能减退的发生率0.60%。年龄、是否Ⅵ区淋巴结清扫、是否甲状旁腺自体移植等是术后24小时发生甲状旁腺激素变化的危险因素。单因素分析结果显示,是否甲状旁腺移植、术后24 h PTH值是影响术后1个月甲状旁腺激素水平的危险因素。结论:Ⅵ区淋巴结清扫、术中甲状旁腺的显露、移植甲状旁腺及数量影响术后不同时期的甲状旁腺激素水平的变化,术中甲状旁腺的血运及功能的保护至关重要。Objective:To investigate the related influencing factors and trend of changes in parathyroid hormone levels after total thyroidectomy,so as to guide clinical treatment.Methods:Retrospective analysis was performed on the data of 180 patients who underwent total thyroidectomy in the department of thyroid surgery,our hospital from July 2015 to July 2017.All patients were given preventive calcium supplement after surgery,and PTH and blood calcium were reviewed 24 hours after surgery.Blood PTH and blood calcium levels were followed up 1 and 6 months after operation.The clinical data of all patients were analyzed.Resutls:The incidence of hypoparathyroidism was 32.20%24 hours after surgery,19.40%1 month after surgery,and 0.60%6 months after surgery.Age,zoneⅥlymph node dissection,and parathyroid autotransplantation were risk factors for parathyroid hormone changes 24 hours after surgery.Univariate analysis showed that whether or not parathyroid transplantation and postoperative 24 h PTH value were the risk factors affecting the level of parathyroid hormone 1 month after surgery.Concluion:Lymph node dissection in zoneⅥ,intraoperative exposure of parathyroid glands,transplantation of parathyroid glands and the number of parathyroid glands affected the changes of parathyroid hormone levels in different postoperative periods.It is very important to protect the blood supply and function of parathyroid gland during operation.

关 键 词：甲状腺全切术 甲状旁腺功能减退 甲状旁腺移植 

分 类 号：R736.2[医药卫生—肿瘤]