外科理论与实践

外科理论与实践 ›› 2020, Vol. 25 ›› Issue (02): 124-128.doi: 10.16139/j.1007-9610.2020.02.008

• 论著 • 上一篇    下一篇

甲状腺切除术后甲状旁腺功能减退的危险因素分析

汪矛斐1, 袁申毅1(), 袁建明1, 刘涛1, 王天翔2, 王明亮2   

  1. 1.上海交通大学医学院附属瑞金医院卢湾分院普外科,上海 200020
    2.上海交通大学医学院附属瑞金医院外科,上海 200025
  • 收稿日期:2019-01-31 出版日期:2020-03-25 发布日期:2020-04-25
  • 通讯作者: 袁申毅,E-mail: Surfacesy@qq.com
  • 基金资助:
    上海市卫生健康委员会资助项目(20134461)

Risk factors for hypoparathyroidism after thyroidectomy

WANG Maofei1, YUAN Shenyi1(), YUAN Jianming1, LIU Tao1, WANG Tianxiang2, WANG Mingliang2   

  1. 1. Department of General Surgery, Luwan Branch, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
    2. Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2019-01-31 Online:2020-03-25 Published:2020-04-25

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摘要：

目的: 旨在分析甲状腺切除术后甲状旁腺功能减退的危险因素。方法: 收集上海交通大学医学院附属瑞金医院卢湾分院普外科2015年1月至2017年12月行甲状腺手术病人的临床资料,分析一般资料、手术相关资料以及围术期检查指标等。Logistic多因素回归分析采用Enter法,评估一过性（<术后6个月）和长期（≥术后6个月）甲状旁腺功能减退的危险因素。结果: 共收集1 381例病人资料,男343例（24.84%）,女1 038例（75.16%）,平均年龄为（47.8±13.0）岁。术后发生一过性甲状旁腺功能减退456例（33.02%）,长期甲状旁腺功能减退21例（1.52%）。多因素分析发现,术后一过性甲状旁腺功能减退相关的危险因素是女性（P<0.001,OR=2.049）、双侧甲状腺切除（P<0.001,OR=2.999）、淋巴结清扫（P=0.001,OR=1.673）、手术时间（P=0.043,OR=1.004）、切除甲状腺最大径（P=0.040,OR=1.144）、术前血钙（P<0.001,OR=0.018）。术后长期甲状旁腺功能减退相关的危险因素是双侧甲状腺切除（P<0.046,OR=3.784）、术后第1天PTH（P<0.001,OR=0.064）。结论: 女性、双侧甲状腺切除、淋巴结清扫、手术时间、术前血钙是甲状腺术后一过性甲状旁腺功能减退的危险因素。双侧甲状腺切除是甲状腺术后长期甲状旁腺功能减退的危险因素,术后第1天PTH对于病人长期甲状旁腺功能减退有预测作用。

关键词: 甲状腺手术, 甲状旁腺功能减退, 危险因素

Abstract:

Objective: To analyze the risk factors for hypoparathyroidism following thyroidectomy. Methods: Data of patients after thyroidectomy were collected retrospectively in Luwan Branch Ruijin Hospital Shanghai Jiao Tong University School of Medicine from January 2015 to December 2017. Demographic and surgical data with perioperative laboratory indexes were analyzed. Logistic regression was used to analyze the risk factors associated with transient (less than 6 months after surgery) and permanent (6 months after surgery) hypoparathyroidism. Results: We collected 1 381 patients with age (47.8±13.0) years old including 343 (24.84%) males and 1 038 (75.16%) females in this study. There were 456 cases (33.02%) with transient hypoparathyroidism and 21 cases (1.52%) with permanent hypoparathyroidism. Multivariate analysis showed that the risk factors associated with transient hypoparathyroidism were female(P<0.001, OR=2.049), bilateral thyroidectomy (P<0.001, OR=2.999), lymph node dissection (P=0.001, OR=1.673), operative time (P=0.043, OR=1.004), maximum diameter of resected thyroid (P=0.040, OR=1.144), preoperative serum calcium (P<0.001, OR=0.018). The risk factors associated with permanent hypoparathyroidism were bilateral thyroidectomy (P<0.046, OR=3.784) and the parathyroid hormone at the first postoperative day (P<0.001, OR=0.064). Conclusions: Female, bilateral thyroidectomy, lymph node dissection, operative time, and preoperative serum calcium were risk factors of transient hypoparathyroidism following thyroidectomy and bilateral thyroidectomy the risk factor of permanent hypoparathyroidism. Parathyroid hormone at the first postoperative day might predict permanent hypoparathyroidism.

Key words: Thyroid surgery, Hypoparathyroidism, Risk factors

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