甲状腺癌首次行甲状腺全切除术后低钙血症影响因素分析

Influencing factors of hypocalcemia after first total thyroidectomy for thyroid carcinoma

目的探讨甲状腺癌首次行甲状腺全切除术后低钙血症的影响因素。方法选取2021年1—12月辽宁省肿瘤医院收治的325例首次行甲状腺全切除术的甲状腺癌患者为研究对象。所有患者均行甲状腺全切除术+双侧中央区淋巴结清扫,同时使用精细化被膜解剖技术保护甲状旁腺。根据患者术后1周内的血钙浓度将患者分为正常组(n=162)与低钙血症组(n=163)。记录并比较两组患者性别、年龄、家族史、肿瘤侧别、病理类型及临床分期T4期、合并桥本甲状腺炎、中央区转移情况、术前甲状旁腺激素(PTH)降低、术前低钙、术前促甲状腺激素(TSH)升高、抗甲状腺过氧化物酶抗体(TPO-Ab)升高比例。采用多因素Logistic回归分析明确甲状腺癌首次行甲状腺全切除术后低钙血症的影响因素。结果两组患者病理类型及合并桥本甲状腺炎、临床分期T4期、TPO-Ab升高比例比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,病理类型、合并桥本甲状腺炎、临床分期均为甲状腺全切除术后发生低钙血症的影响因素(P<0.05)。结论病理类型、临床分期、合并桥本甲状腺炎均为甲状腺全切除术后发生低钙血症的影响因素,对肿瘤恶性程度高、临床分期晚或伴有桥本甲状腺炎的高危患者,应加强术前评估,术中注重减轻甲状旁腺损伤,可以最大限度地减少低钙血症的发生。

Objective To investigate the influencing factors of hypocalcemia after the first total thyroidectomy for thyroid carcinoma.Methods A total of 325 patients with thyroid cancer who underwent total thyroidectomy for the first time in Liaoning Cancer Hospital from January to December 2021 were selected as the research objects.All patients underwent total thyroidectomy and bilateral central lymph node dissection,and the parathyroid glands were protected by fine capsule dissection.The patients were divided into normal group(n=162)and hypocalcemia group(n=163)according to the blood calcium concentration within 1 week after operation.Record and compare the two groups of patients with gender,age,family history,location of tumor,pathological type and the proportion of clinical T4 staging,merging hashimoto thyroiditis,central transfer situation,preoperative parathyroid hormone(PTH)reduced,preoperative low calcium,preoperative thyroid stimulating hormone(TSH)rised,preoperative antithyroid peroxidase antibody(TPO-Ab)rised.Multivariate Logistic regression analysis was used to identify the influencing factors of hypocalcemia after the first total thyroidectomy for thyroid carcinoma.Results There were significant differences in the pathological types and the proportion of patients with Hashimoto′s thyroiditis,clinical stage T4 and TPO-Ab elevation between the two groups(P<0.05).Multivariate Logistic regression analysis showed that pathological type,hashimoto′s thyroiditis and clinical stage were the influencing factors of hypocalcemia after total thyroidectomy(P<0.05).Conclusion Pathological type,clinical stage,combination of hashimoto thyroiditis were total resection of thyroid occurs after the influence factors of hypocalcemia,on the high degree of malignant tumor,clinical stage,late or high-risk patients with hashimoto′s thyroiditis,should strengthen the preoperative evaluation,intraoperative pay attention to reduce parathyroid injury,can minimize the occurrence of hypocalcemia.