| 摘要: |
| 目的 探讨甲状腺切除术后低钙血症及甲状旁腺功能减退（hypoparathyroidism，HPP）的危险因素和防治措施。方法 回顾性分析第二军医大学长海医院2016年1月1日至6月30日收治的449例因各类甲状腺疾病而行甲状腺切除术患者的临床资料，其中男性95例、女性354例，平均年龄（48.99±12.81）岁。运用EmpowerStats与R软件，采用平滑曲线拟合、阈值效应分析、单因素分析及多因素分析，筛选术后发生低钙血症及HPP的危险因素。结果 449例患者中，出现甲状旁腺激素（parathyroid hormone，PTH）低于正常值者共27例（6.01%），低钙血症43例（9.58%）；暂时性HPP 23例（5.12%），其中1例可能发展为永久性HPP。术后PTH较术前每下降1%，术后低钙血症发生风险增加4%（P<0.000 1）。甲状腺癌患者术后出现HPP风险最高，其次为结节性甲状腺肿、甲状腺功能亢进，6种甲状腺疾病术后HPP发生率差异有统计学意义（P<0.05）。手术切除范围越大，HPP发生率越高，双侧次全切以上的手术加中央区淋巴结清扫是术后发生HPP的危险因素（P<0.05）。结论 甲状腺疾病病理类型、手术方式及难度是影响术后甲状旁腺功能的重要因素，术后PTH水平的变化对低钙血症及HPP的发生有重要的预测作用。 |
| 关键词: 甲状腺切除术 甲状旁腺功能减退症 低钙血症 甲状旁腺激素 |
| DOI：10.16781/j.0258-879x.2017.10.1267 |
| 投稿时间：2017-03-13修订日期：2017-08-24 |
| 基金项目: |
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| Risk factors of hypoparathyroidism after thyroidectomy |
| YAN Gui-ling1,HU Wei1*,WU Yu-shou2,QU Wen-long3 |
(1. Department of Thyroid and Breast Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Medical Team of No. 62312 Troop of PLA, Beijing 100032, China;
3. Beijing Dongdaqiao Retired Cadre Santatorium of Air Force, Beijing 100020, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the risk factors and prevention measures of hypocalcemia and hypoparathyroidism (HPP) after thyroidectomy. Methods Clinical data of 449 patients with thyroid diseases, who received thyroidectomies in the Department of Thyroid and Breast Surgery of Changhai Hospital of Second Military Medical University from Jan.1 to Jun.30, 2016 were retrospectively analyzed, including 95 males and 354 females, with an average age of (48.99±12.81) years old. The risk factors of post-operative hypocalcemia or HPP were screened by smooth curve fitting, threshold effect analysis, one-way ANOVA analysis and multivariate analysis using the EmpowerStats and R software. Results Among the 449 patients, 27 cases (6.01%) developed lower parathyroid hormone (PTH), 43 (9.58%) developed hypocalcemia, and 23 (5.12%) developed transient HPP, of which one patient might develop permanent HPP. The risk of post-operative hypocalcemia was increased by 4% for every 1% decrease in post-operative PTH (P<0.000 1). Patients with thyroid carcinoma had the highest risk of HPP, followed by nodular goiter and hyperthyroidism. There was significant difference in the incidence of HPP among patients with six thyroid diseases(P<0.05). The larger of surgical resection range, the higher the incidence of HPP. Bilateral total/subtotal thyroidectomy plus central lymph node dissection in central area was a risk factor of the post-operative HPP (P<0.05). Conclusion The thyroid pathological type, surgical method and difficulty are important factors influencing the parathyroid function after thyroidectomy. Post-operative change of PTH levels has an important role in predicting the incidence of HPP and hypocalcemia. |
| Key words: thyroidectomy hypoparathyroidism hypocalcemia parathyroid hormone |
