甲状腺全切除术后暂时性甲状旁腺功能减退危险因素分析

Analysis of the risk factors of hypoparathyroidism following total thyroidectomy

目的探讨甲状腺全切除术后暂时性甲状旁腺功能减退发生的危险因素及术后常规补钙的临床价值。方法回顾性分析2017年1-10月于北京大学深圳医院行甲状腺全切除术的237例病人资料,所有病人术后当天给予预防性补钙,且于术后第1天均复查甲状腺素(PTH)、血钙,术后1、3、6个月随访PTH及血钙水平。统计所有病人的临床数据并进行数据分析。结果 (1)237例中出现术后甲状旁腺功能减退的病人139例(58.6%),其中暂时性甲状旁腺功能减退的病人136例(57.3%),永久性甲状旁腺功能减退3例(1.3%)。(2)不同年龄、性别、手术路径与术后暂时性甲状旁腺功能减退发生率差异无统计学意义(P>0.05)。(3)淋巴结清扫范围、是否再次手术及是否误切甲状旁腺与术后暂时性甲状旁腺功能减退发生率差异有统计学意义(P<0.05)。结论 (1)术后暂时性甲状旁腺功能减退与年龄、性别、手术路径无关,淋巴结清扫范围大、再次手术及甲状旁腺误切更容易导致甲状旁腺功能减退。(2)术后第1天检测PTH能较血钙更好地预测术后甲状旁腺功能减退的发生情况。(3)术后预防性使用钙剂及维生素D3可有效预防低钙血症的发生。

Objective To investigate the risk factors of transient hypoparathyroidism after total thyroidectomy and the clinical value of routine postoperative calcium supplementation. Methods The data of 237 patients performed total thyroidectomy in Peking University Shenzhen Hospital from January 2017 to October 2017 were analyzed retrospectively. All the patients were given calcium supplementation on the day of operation prophylactically. Meanwhile, PTH and Ca2＋ were reexamined on the first day after operation. The clinical data of all the patients were collected and analyzed. Results （1） Among the patients, hypoparathyroidism was occurred in 139 cases （58.6%）. Three cases （1.3%） were permanent hypoparathyroidism and 136 cases （57.3%） were transient hypoparathyroidism. （2） There was no significant difference in the incidence of transient hypoparathyroidism among different age, sex, and surgical pathway （P〉0.05）. （3） The scope of lymph node dissection, reoperation and whether the parathyroid glands were misdissection had statistical significance in the incidence of postoperative hypoparathyroidism （P〈0.05）. Conclusion （1） Wider lymphadenectomy, complicated surgery and incidental parathyroidectomy are the risk factors of transient hypoparathyroidism.（2） The detection of PTH on the first day after operation can predict postoperative hypoparathyroidism better than serum calcium. （3） Regular supplement of calcium and calctriol can avoid hypocalcemia effectively.