甲状腺术后甲状旁腺功能减退和低钙血症影响因素分析

Clinical analysis of post-thyroidectomy hypoparathyroidism and hypocalcaemia

目的探讨甲状腺术后低钙血症和甲状旁腺功能减退的影响因素以及资料分析。方法回顾江苏省肿瘤医院头颈外科2016年1月至2017年1月收治的183例经手术治疗的甲状腺疾病患者手术后低钙血症和甲状旁腺功能减退情况。分析年龄、性别、病理诊断、中央区淋巴结清扫、颈侧区淋巴结清扫、手术范围、手术时间、术前血钙水平、术前甲状旁腺激素水平与术后甲状旁腺功能减退及低钙血症的关系。结果 183例术后病理诊断为甲状腺癌163例(89.07%),甲状腺其他疾病20例(10.93%)。术后141例甲状旁腺功能正常的患者中7例(4.96%)发生低钙血症,42例甲状旁腺功能减退的患者中26例(61.91%)发生低钙血症。单因素分析显示,性别、中央区淋巴结清扫、颈侧区淋巴结清扫、手术范围、手术时间、术前甲状旁腺激素水平与术后甲状旁腺功能减退相关。年龄、性别、中央区淋巴结清扫、颈侧区淋巴结清扫、手术范围、手术时间与术后低钙血症相关。结论手术范围大、女性、行中央区淋巴结清扫、行颈侧区淋巴结清扫、手术时间长、术前甲状旁腺激素水平低的患者术后甲状旁腺功能减退的发生率高。手术范围大、年龄较大、女性、行中央区淋巴结清扫、行颈侧区淋巴结清扫以及手术时间长的患者术后低钙血症的发生率高。

Objective This study aimed to investigate the influencing factors for post-thyroidectomy hy- pocalcaemia and hypoparathyroidism as well as the prevention and treatment for postoperative hypocaIcaemia. Methods A total of 183 patients undergoing thyroidectomy in Jiangsu Cancer Hospital were preoperatively and postoperatively assessed for hypocalcemia and hypoparathyroidism. Analyses were performed to evaluate potential elinicopathologic factors for hypocalcaemia and hypoparathyroidism according to age, gender, histopathological diagnosis, central neck dissection, lateral neck dissection, extent of operation, operative time, preoperative ser- um parathyroid hormone （PTH） level, and preoperative serum calcium level. Results A total of 163 patients were diagnosed as thyroid cancer in the 183 patients （89.07%） , 20 patients were with other thyroid diseases （10. 93% ）. Hypocalcemia was found in 7 patients （4. 96% ） from the 141 patients with normal parathyroid function, and in 26 patients （61.91%） from the 42 patients with hypoparathyroidism. From the 42 patients with hypoparathyroidism, 16 patients （38. 09% ） were without the occurrence of hypocaleemia. The drop-out value of preoperative and postoperative PTH was negative correlated to postoperative calcium. Univariate analy-sis showed that gender, central neck dissection, lateral neck dissection, extent of operation, operative time, and preoperative serum P＇I＇H were related to hypoparathyroidism. Age, gender, central neck dissection, lateral neck dissection, extent of operation and operative time were the factors related to hypocalcaemia~ Conclusions The risk factors of post-thyroidectomy hypoparathyroidism include female, central neck dissection, lateral neck dissection, large extent of operation, long operative time and low preoperative PTH level. The risk factors of post-thyroidectomy hypocalcaemia include order age, female, central neck dissection, lateral neck dissection, large extent of operation and long operative time.