甲状腺癌患者全切除术后甲状旁腺激素水平变化及影响因素分析  

Analysis of changes in parathyroid hormone levels and influencing factors in patiehs with thyroid cancer affer total fhyroidectomy

作　　者：丁小云 唐振宁 吴立刚 刘奇伦 DING Xiaoyun;TANG Zhenning;WU Ligang;LIU Qilun(Tumor Hospital,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肿瘤医院肿瘤外科,宁夏银川750004

出　　处：《宁夏医学杂志》2024年第8期661-664,共4页Ningxia Medical Journal

摘　　要：目的探讨甲状腺癌患者全切除术后甲状旁腺激素(PTH)水平变化及影响因素,并为预测低钙症状的发生及治疗提供参考。方法回顾性分析173例甲状腺全切患者,按照具体手术方式分为4组,A组63例(甲状腺全切除术或全甲状腺切除伴单侧VI区淋巴结清扫术)、B组62例(甲状腺全切除术伴双侧VI区淋巴结清扫术)、C组19例(甲状腺全切除伴甲状旁腺移植术或甲状腺全切除术伴单侧VI区颈清扫术及甲状旁腺移植术)、D组29例(甲状腺全切除术伴双侧VI区淋巴结清扫术及甲状旁腺移植术)。动态监测手术前后血钙及血PTH水平的变化。结果173例术后检测PTH值降低107例,正常66例。暂时性甲状腺旁腺功能减低(T-HPT)是甲状腺全切除术后常见的并发症,本研究中发生率是61.85%。单因素分析显示术后发生T-HPT,与性别、手术方式、中央区淋巴结清扫数量≥4枚、甲状旁腺误切、多病灶,合并桥本氏甲状腺炎或结节性甲状腺肿及是否使用纳米碳有相关性,差异有统计学意义(P<0.05)。logistic多因素回归分析显示,性别、手术方式、甲状旁腺误切、合并桥本氏甲状腺炎或结节性甲状腺肿及未使用纳米碳是术后发生T-HPT的危险因素,差异有统计学意义(P<0.05)。结论性别、手术方式、甲状旁腺误切、合并桥本氏甲状腺炎或结节性甲状腺肿、病灶数及未使用纳米碳是术后发生T-HPT的独立危险因素,术后第1天测血PTH值是预测术后发生低钙血症的敏感指标。Objective To explore the changes and influencing factors of PTH(Parathyroid hormone)levels after the total thyroidectomy,and provide the theoretical basis for predicting the occurrence and treatment of hypocalcemia symptoms.Methods A retrospective analysis was conducted on 173 patients with total thyroidectomy,who were divided into four groups according to specific surgical methods:Group A(87 cases)underwent total thyroidectomy or total thyroidectomy with unilateral VI lymph node dissection,Group B(38 cases)underwent total thyroidectomy with bilateral VI lymph node dissection,Group C(34 cases)underwent total thyroidectomy with parathyroid gland transplantation or total thyroidectomy with unilateral VI neck dissection and parathyroid gland transplantation,Group D(14 cases)underwent total thyroidectomy with bilateral VI lymph node dissection and parathyroid gland transplantation.The changes levels of calcium and PTH in the blood were dynamically monitored before and after surgery.Results Out of 173 postoperative cases,107 cases showed a decrease in PTH levels,while 66 cases showed normal results.The incidence rate of temporary hypothyroidism(T-HPT)was 61.85%.Univariate analysis showed that the occurrence of T-HPT after surgery was correlated with female gender,surgical method,number of central lymph node dissection≥4,parathyroid gland misresection,multiple lesions,and postoperative calcium supplementation,with statistically significant differences(P<0.05).Logistic multivariate regression analysis showed that gender,surgical method,parathyroid gland resection,and the presence of Hashimoto′s thyroid or thyroid nodules were risk factors for postoperative T-HPT,with statistically significant differences(P<0.05).Conclusion Gender,surgical methods,parathyroid gland resection,combined with Hashimoto′s thyroiditis or thyroid nodules are the related risk factors for postoperative T-HPT.Measure the blood PTH value on the first day after surgery can predict the occurrence of hypocalcemia after surgery.

关 键 词：甲状腺癌 甲状腺全切除术 甲状旁腺激素减低 低钙血症 

分 类 号：R246.5[医药卫生—针灸推拿学]