甲状腺全切除术后低钙血症危险因素分析

Analysis of risk factors for hypocalcemia post total-thyroidectomy

目的:分析甲状腺全切术后低钙血症的影响因素。方法:回顾性总结200例甲状腺全切除术患者的各临床、病理因素和术后甲状旁腺素(PTH)及血钙水平的差别,分析术后出现低钙血症的影响因素。结果:200例患者中出现术后低钙血症104例(52.0%),甲状旁腺功能低下90例(45.0%),出现持续性低钙血症26例(13.0%)。多因素分析结果显示,甲状旁腺功能低下的危险因素有被膜侵犯(P<0.001)、甲状旁腺的意外切除(P=0.005)及双侧颈淋巴结清除术(P=0.006);而对血钙有影响的因素为病理(P<0.001)、性别(P=0.002);术后有无补充钙剂与术后甲状旁腺素(P=0.016)及血钙降低(P=0.003)均显著相关。术后甲状旁腺功能低下是持续性低钙血症的唯一相关因素,P<0.001。结论:甲状腺全切术后低钙血症的发生率较高,术后应及时复查PTH及血钙水平。女性、甲状腺恶性病变、被膜受侵及双侧颈淋巴结清除术的患者易出现甲状旁腺功能降低及低钙血症,应对上述患者常规补充钙剂,根据PTH及血钙水平调节补充钙剂的剂量,对PTH明显降低的患者应进行长期随诊。

OBJECTIVE：To analyze the influencing factors for hypo-parathyroidism and hypocalcemia post total-thyroidectomy.METHODS： The clinical data of 200 patients undergoing total or complete total thyroidectomy with and without neck dissection were reviewed retrospectively.Postoperative serum parathyroid hormone and calcium level were compared and the influencing ones were identified with binary Logistic regression.RESULTS： One hundred and four（52.0%） out of 200 patients were diagnosed transient hypocalcemia and 26（13.0%） with persist symptoms.Ninety patients（45.0%） had a declined parathyroid hormone level.Post-operative hypocalcemia and hypoparathyroidism were statistically associated with hypocalcemia symptoms.The risk factors for post total-thyroid hypoparathyroidism were capsule invasion（P0.001）,inadvertent parathyroidectomy（P=0.005）,and bilateral neck dissection（P=0.006）.For hypocalcemia the risk factors were malignant tumor（P0.001） and female（P=0.002）.Intravenous calcium supplement was statistically associated with both hypoparathyroidism（P=0.016） and hypocalcemia（P=0.003）.Post-operative hypopevrathyrorclion was the only prognoseic factor for persistant hypocalcemia（P0.001）.CONCLUSIONS： The indications for total thyroidectomy should be properly handled because of the high incidence of hypocalcemia.Malignant tumors,capsule invasion,bilateral neck dissection and female are risk factors for hypoparathyroidism and hypocalcemia.PTH and serum calcium level should be measured after total-thyroidectomy and calcium should be routinely supplemented for patients with high risk factors.The treatment policy can be modulated according to the level of PTH and serum calcium.Follow-up is recommended for patients with transient hypoparathyroidism.