甲状腺切除术后并发低钙血症及甲状旁腺功能减退的危险因素分析

Risk factors of hypocalcemia and hypoparathyroidism after thyroidectomy

目的 探讨甲状腺切除术后并发低钙血症及甲状旁腺功能减退的危险因素.方法 回顾性分析2016年9月至2017年10月于菏泽市第三人民医院行甲状腺切除术260例患者的临床资料.术后检查甲状旁腺激素(PTH)及血钙浓度,运用单因素分析及多因素分析筛选术后并发甲状旁腺功能减退及低钙血症的相关危险因素.结果 260例行甲状腺切除术患者中,术后并发甲状旁腺功能减退60例(23.08%),并发低钙血症47例(18.08%).单因素分析结果显示,术后甲状旁腺功能减退与颈部淋巴结清扫、性别、手术范围、手术时间、中央区淋巴结清扫、术前PTH水平有关(P<0.05);Logistic多因素分析显示,手术范围、性别、术前PTH水平是导致甲状旁腺功能减退的独立危险因素(P<0.05,OR>1).经单因素分析显示,术后低钙血症与颈部淋巴结清扫、性别、手术范围、手术时间、中央区淋巴结清扫、年龄有关(P<0.05);经Logistic多因素分析显示,手术范围及年龄是导致低钙血症的独立危险因素(P<0.05,OR>1).结论 手术范围大、高龄是导致术后低钙血症的主要危险因素;女性、手术范围大、术前PTH水平较低是术后并发甲状旁腺功能减退的主要危险因素.

Objective To investigate the risk factors of hypocalcemia and hypoparathyroidism after thyroidectomy.Methods Clinical data of 260 patients who underwent thyroidectomy in the Third People's Hospital of Heze from September 2016 to October 2017 were retrospectively analyzed.Postoperative parathyroid hormone(PTH)and serum calcium concentration of the 260 patients were examined.Univariate analysis and multivariate analysis were used to screen the risk factors of postoperative hypothyroidism and hypocalcemia.Results Among the 260 patients who underwent thyroidectomy in the study,60 cases(23.08%)were complicated with hypoparathyroidism,and 47 cases(18.08%)were complicated with hypocalcemia.Univariate analysis showed that postoperative hypoparathyroidism was associated with cervical lymph node dissection,gender,surgical range,operation time,central region lymph node dissection and preoperative PTH level(P<0.05).Logistic multivariate analysis showed that the operative range,gender and preoperative PTH level were independent risk factors for hypoparathyroidism(P<0.05,OR>1).According to univariate analysis,postoperative hypocalcemia was associated with cervical lymph node dissection,gender,operation range,operation time,central region lymph node dissection,and age(P<0.05).Logistic multivariate analysis showed that operation range and age were independent risk factors of hypocalcemia(P<0.05,OR>1).Conclusions Large operation range and high age are the main risk factors for postoperative hypocalcemia.The main risk factors for postoperative hypoparathyroidism are female,large surgical range and low preoperative PTH level.