甲状腺术后甲状旁腺功能监测及功能减退的危险因素分析

Analysis of Risk Factors for Parathyroid Function Monitoring and Hypofunction after Thyroid Surgery

目的探析甲状腺术后甲状旁腺功能监测的意义及功能减退的危险因素。方法选取2014年1月—2018年12月于该院行甲状腺切除术治疗的患者131例,观察患者手术前、手术后1 d及3 d的甲状旁腺激素水平、手术后甲状旁腺功能减退的发生情况及导致甲状旁腺功能减退的因素。结果患者手术后1 d及3 d的血清甲状旁腺激素水平分别为(26.18±9.63)pg/mL和(31.47±10.42)pg/mL,均明显低于手术前的(45.94±17.39)pg/mL,差异有统计学意义(t=11.377、8.169,P=0.000、0.000),且患者手术后1 d及3 d的血清甲状旁腺激素水平差异有统计学意义(t=4.267,P=0.000)。甲状旁腺功能减退发生率为29.77%,其中暂时性减退发生率为71.79%,永久性减退发生率为28.21%。双侧病变、恶性肿瘤、甲状腺全切术、淋巴结清扫术和再次手术是甲状腺切除术后甲状旁腺功能减退的主要因素(P<0.05),其中双侧病变、甲状腺全切除术、淋巴结清扫术和再次手术是甲状腺切除术后永久性甲状腺功能减退的主要因素(P<0.05)。结论甲状腺术后甲状旁腺功能减退与病变部位、手术范围、是否行淋巴结清扫术和手术次数等因素有关。

Objective To investigate the significance of parathyroid function monitoring after thyroid surgery and the risk factors of hy-pofunction.Methods A total of 131 patients who underwent thyroidectomy in the hospital from January 2014 to December 2018 were enrolled.The parathyroid hormone levels before and after surgery,1 day and 3 days after surgery,and parathyroid hypofunction were observed as well as the occurrence and causes of hypoparathyroidism.Results Serum parathyroid hormone levels at 1 and 3 days after surgery were(26.18±9.63)pg/mL and(31.47±10.42)pg/mL,respectively,which were significantly lower than those before surgery(45.94±17.39)pg/mL,the difference was statistically significant(t=11.377,8.169,P=0.000,0.000),and the serum parathyroid hormone levels were statistically significantly different between 1 day and 3 days after surgery(t=4.267,P=0.000).The incidence of hypoparathyroidism was 29.77%,of which the incidence of temporary decline was 71.79%,and the incidence of permanent decline was28.21%.Bilateral lesions,malignant tumors,total thyroidectomy,lymph node dissection,and reoperation were the main factors for hy-poparathyroidism after thyroidectomy(P<0.05),including bilateral lesions,total thyroidectomy,and lymph node dissection.And reoperation was the main cause of permanent hypothyroidism after thyroidectomy(P<0.05).Conclusion Hypoparathyroidism after thyroid surgery is related to the location of the lesion,the scope of surgery,lymph node dissection and the number of operations.