甲状腺癌全切术后监测引流液及血清甲状旁腺素的临床意义  

Clinical significance of monitoring parathyroid hormone in drainage fluid and serum after total thyroidectomy

作　　者：高虹[1] 佟凌霞[2] 宋波[3] 郑鹏远[2] 金慧[1] Gao Hong;Tong Lingxia;Song Bo;Zheng Pengyuan;Jin Hui(Department of Thyroid and Head Neck Surgery,Jilin Tumor Hospital,Changchun 130012,China;Department of Ultrasound,Jilin Tumor Hospital,Changchun 130012,China;Department of Nuclear Medicine Jilin Tumor Hospital,Changchun 130012,China)

机构地区：[1]吉林省肿瘤医院甲状腺头颈外科,长春130012 [2]吉林省肿瘤医院超声科,长春130012 [3]吉林省肿瘤医院核医学科,长春130012

出　　处：《中华内分泌外科杂志》2022年第5期579-583,共5页Chinese Journal of Endocrine Surgery

基　　金：吉林省卫生健康科技创新自筹经费项目(2019zc012)。

摘　　要：目的通过监测甲状腺全切(total-thyroidectomy,TT)术后血清及引流液中甲状旁腺激素(parathyroid hormone,PTH)水平及变化情况,观察不同的临床因素对术后PTH水平的影响及预测术后发生永久性甲状腺功能低下(permanent hypoparathyroidism,PHP)的可能性。方法回顾性分析吉林省肿瘤医院甲状腺头颈外科2020年1月至2021年8月因甲状腺乳头状癌(papillary thyroid carcinoma,PTC)行TT的患者150例,记录术后1、3、7及30 d和6个月患者血清PTH的变化情况,通过统计及比较各组间的性别、肿瘤最大径、手术范围等临床资料数据,采用单因素及多因素方法,寻找术后出现甲状旁腺功能低下(hypoparathyroidism,HP)的危险因素。同时结合术后1 d引流液中PTH水平,预测甲状旁腺功能受损情况。结果绝大多数TT患者,术后1个月血清中PTH可恢复正常,PHP的发生率为3.33%(5/150)。单因素表明双侧中央区淋巴结清扫(bilateral central neck dissection,BCND)、合并桥本氏甲状腺炎、肿瘤最大径≥2 cm及术中进行选择性甲状旁腺自体移植是术后暂时性甲状旁腺功能低下(temporary hypoparathyroidism,THP)的危险因素(P<0.05);多因素Logistic回归分析显示术中进行BCND(OR=0.322,P=0.001)、选择性甲状旁腺自体移植(OR=5.442,P=0.001)及甲状腺癌灶最大径≥2 cm(OR=2.247,P=0.003)是术后THP的独立危险因素。应用ROC曲线比较术后血清及引流液PTH水平对术后PHP的预测作用,统计结果表明术后1周内,第1天引流液中PTH水平对术后PHP预测作用最大,AUC为0.81。将术后第1天血清PTH低于正常值的54例,按引流液中PTH由高到低分为4组进行分析,结果引流液中PTH水平越低,发生PHP的可能性越大(P<0.05)。结论术后超过1个月仍为THP的患者,绝大多数会发展为PHP。BCND、术中选择性甲状旁腺移植、肿瘤最大径≥2 cm是PTC行TT的患者术后THP的危险因素。术后第1天血清PTH低于正常值,同时引流液中PTH越低,发�Objective To observe the effect of different clinical factors on the level of parathyroid hormone(PTH)and to predict the possibility of permanent hypothyroidism(PHP)after total thyroidectomy(TT)by monitoring the levels of PTH in serum and drainage fluid after TT.Methods Retrospective analysis was made on 150 patients who underwent TT for papillary thyroid carcinoma(PTC)in the Department of Thyroid Head and Neck Surgery in Jilin Cancer Hospital from Jan.2020 to Aug.2021.The changes of serum PTH were recorded at 1,3,7,30 days and 6 months after surgery.The risk factors of postoperative hypoparathyroidism(HP)were investigated by single factor and multi factor methods.The impairment of parathyroid function was predicted combined with the level of PTH in the drainage fluid 1 day after operation.Results After TT,serum PTH returned to normal value in most patients 1 month after operation.The proportion of PHP was 3.33%(5/150).Univariate analysis showed that bilateral central lymph node dissection,Hashimoto’s thyroiditis,tumor diameter≥2 cm and intraoperative selective parathyroid autologous transplantation were risk factors for temporary hypoparathyroidism(THP).Multivariate analysis showed that BCND(OR=0.322,P=0.001),intraoperative selective parathyroid autograft(OR=5.442,P=0.001)and tumor diameter≥2 cm(OR=2.247,P=0.003)were independent risk factors for THP.ROC curve was used to compare the predictive effect of postoperative serum and drainage PTH levels on postoperative PHP.The statistical results showed that the highest predictive effect of postoperative PHP was found on the first day of drainage PTH level within 1 week after operation(AUC 0.81).54 cases whose serum PTH was lower than normal value on the first day after operation were divided into 4 groups according to the level of PTH in drainage fluid from high to low.The results showed that the lower the level of PTH in drainage fluid,the greater the possibility of PHP(P<0.05).Conclusions Most of the patients with low PTH one month after operation develop PHP

关 键 词：甲状腺乳头状癌 甲状腺全切 甲状旁腺激素 甲状旁腺功能低下 

分 类 号：R736.1[医药卫生—肿瘤]