分化型甲状腺癌根治术并发症及其影响因素分析

COMPLICATIONS AND THEIR RISK FACTORS OF RADICAL THYROIDECTOMY IN PATIENTS WITH DIFFERENTIATED THYROID CARCINOMA

目的探究并分析分化型甲状腺癌患者根治术术中、术后并发症情况及其影响因素。方法研究对象来自我院2010年1月—2013年1月收治的375例分化型甲状腺癌根治术患者,采用笔者查阅大量参考文献后编制的自编问卷收集分化型甲状腺癌根治术患者临床资料,采用描述性统计和二分类Logistic回归分析找出分化型甲状腺癌患者根治术术中、术后并发症情况及其影响因素。结果分化型甲状腺癌患者根治术术中、术后并发症发生率为14.40%(54/375),以手术部位感染、喉返神经损伤和低钙血症为多见。单因素Logistic回归分析示高龄(OR=6.22,P=0.000)、淋巴结远处转移(OR=6.41,P=0.000)、营养不良(OR=16.83,P=0.000)、糖化血红蛋白水平高(OR=18.79,P=0.000)、基础疾病种类>3种(OR=4.88,P=0.000)和侵入性操作>3种(OR=4.58,P=0.000)是分化型甲状腺癌患者出现术中、术后并发症的危险因素。多因素Logistic回归分析示高龄(OR=6.92,P=0.000)、营养不良(OR=10.04,P=0.000)和糖化血红蛋白水平高(OR=12.87,P=0.000)是分化型甲状腺癌患者出现术中、术后并发症的危险因素。结论分化型甲状腺癌患者术中、术后并发症发生率较高,以手术部位感染、喉返神经损伤和低钙血症为多见,其发生受多方面因素影响,在临床工作中,我们应该强化医务人员患者营养支持重要性,优化血糖控制方案,有效控制血糖,尤其是针对高危人群,减少分化型甲状腺癌患者术中、术后并发症发生,改善患者的预后。

Objective To evaluate complications during intraoperative or postoperative and their influencing factors for patients undergoing radical thyroidectomy for differentiated thyroid carcinoma. Methods Totally 375 cases of differentiated thyroid carcinoma receiving radical thyroidectomy for their differentiated thyroid carcinoma between January 2010 and January 2013 were collected from author＇s hospital. Clinical data of the patients were analyzed with a questionnaire composed by literature review. Intraoperative or postoperative complications and their influencing factors were identified using descriptive statistics and binary logistic regression analysis. Results Intraoperative or postoperative complications occurred in 14. 40% （54/375） of the patients with differentiated thyroid carcinoma. Among the complications, surgical site infection, recurrent laryngeal nerve injury and hypocalcemia were most commonly complication. Univariate logistic regression analysis showed that advanced age （OR = 6.22,P = 0. 000）, lymph node metastasis （OR = 6.41, P = 0. 000）, malnutrition （OR = 16.83, P = 0. 000）, increased glycosylated hemoglobin （OR = 18.79 ,P = 0. 000）, more than 3 types of underlying diseases （OR = 4.88,P = 0. 000） and more than 3 types of invasive procedures （OR = 4.58,P = 0. 000） were risk factors for intraoperative or postoperative complications in patients with differentiated thyroid carcinoma. Multivariate logistic regression analysis revealed that advanced age （OR = 6.92,P = 0. 000）, malnutrition （OR = 10.04, P = 0. 000） and increased glycosylated hemoglobin （OR = 12.87,P = 0. 000） were risk factors for intraoperative or postoperative complications in patients with differentiated thyroid carcinoma. Conclusion There is a high incidence of intraoperative or postoperative complications in patients receiving radical thyroidectomy for their differentiated thyroid carcinoma, most common complications are advanced age, malnutrition and increased glycosylated hemoglobin.