甲状腺全切除术和近全切除术术后甲状旁腺功能损伤的危险因素分析

摘要

Objective To study the risk factors for postoperative hypoparathyroidism or hypocalcemia.Methods Totally 414 patients with thyroid diseases who underwent total or near total thyroidectomy at Department of Head and Neck Surgery,Peking University Cancer Hospital and Institute from June 2007 to June 2014 were studied retrospectively.There were 119 male and 295 female patients with a median age of 47 years.The clinical and pathological features that related to post-operative hypoparathyroidism were studied by x2 test and multivariate Logistic regression analysis.Results Of the 414 patients,36.2％ developed transient hypocalcemia,36.5％ developed transient hypoparathyroidism,2.2％ developed permanent hypoparathyroidism.In regression analysis,unilateral or bilateral center lymph node dissection were associated with mild transient hypocalcemia after surgery (OR =2.366,P =0.022;OR =5.216,P =0.000);unilateral or bilateral center lymph node dissection as well as surgical options were significant risk factors for severe transient hypocalcemia (OR =4.029,P =0.001;OR =8.384,P =0.000;OR=2.073,P =0.017) and hypoparathyroidism (OR =1.755,P =0.040;OR =4.144,P =0.000;OR =2.287,P =0.000).The parathyroid hormone concentration on postoperative day 1 was an independent risk factor for permanent hypoparathyroidism (OR =2.011,P =0.014).The concentration of parathyroid hormone threshold ＜ 5.28 ng/L was a predictor to permanent hypoparathyroidism with accuracy of 95.0％.Conclusions Bilateral center lymph node dissection is a risk factor of permanent hypoparathyroidism in patients received total thyroidectomy should be taken thoughtfully.The parathyroid hormone concentration on postoperative day 1 provides better prediction for persistent hypoparathyroidism.%目的 探讨甲状腺全切除术和近全切除术患者术后发生低钙血症的危险因素.方法 对北京大学肿瘤医院头颈外科2007年6月至2014年6月行甲状腺全切除或近全切除的414例甲状腺癌及甲状腺良性病变患者进行回顾性分析.男性119例,女性295例,中位年龄47岁.采用x2检验、多分类Logistic回归分析筛选术后发生低钙血症及低甲状旁腺素(PTH)血症的危险因素,采用受试者工作特征曲线下面积(AUC)计算PTH水平预测永久性甲状旁腺功能损伤的准确率.结果 414例患者中发生暂时性低钙血症、暂时性甲状旁腺功能低下、永久性甲状旁腺功能损伤的比例分别为36.2％、36.5％、2.2％.单侧、双侧Ⅵ区淋巴结清扫是暂时性轻度低钙血症的独立危险因素(OR=2.366,P=0.022;OR=5.216,P=0.000);单侧、双侧Ⅵ区淋巴结清扫及手术切除方式是暂时性重度低钙血症的独立危险因素(OR=4.029,P=0.001;OR =8.384,P=0.000;OR =2.073,P=0.017),上述三个指标也是暂时性低PTH血症的独立危险因素(OR=1.755,P=0.040;OR =4.144,P=0.000;OR=2.287,P=0.000).术后第1天PTH水平是影响永久性甲状旁腺功能损伤的独立危险因素(OR =2.011,P=0.014);以临界值5.28 ng/L预测永久性甲状旁腺功能损伤,AUC为95.0％.结论 双侧Ⅵ区淋巴结清扫是甲状腺全切除术患者发生甲状旁腺功能损伤的重要影响因素.术后第1天PTH水平可以更好地预测永久性甲状旁腺功能损伤的发生.