再次甲状腺癌术后低钙血症的危险因素分析

Predictive factors for postoperative hypocalcemia after reoperation of thyroid cancer

目的甲状旁腺功能减退症(简称:甲旁减)是再次甲状腺癌手术最常见的并发症之一,本研究旨在分析再次甲状腺癌术后低钙血症的危险因素,正确指导术后补钙管理,缩短平均住院日。方法回顾性分析浙江大学附属第一医院甲状腺外科2013年6月至2018年6月之间106例因甲状腺癌复发而再次手术患者。术前依据手术范围所涉及的甲状旁腺区域对再次手术分级为:低危组、中危组及高危组。术后12-24h监测甲状旁腺激素(PTH)与总钙(Ca)水平。术后随访时间>6个月。ROC曲线分析术后低钙血症的PTH切点值,单因素及多因素分析再次术后低钙血症的危险因素。结果再次手术后暂时性甲旁减发生率为35.0%,永久性甲旁减为1.9%,术前再次手术甲旁减危险度级别的高低与术后甲旁减呈正相关。ROC曲线分析术后低钙血症的PTH切点值为15pg/ml,曲线下面积为0.636(95%置信区间:0.530~0.742,P<0.017)o多因素研究表明术前再次手术分级(P=0.025)及术后PTH<15pg/ml(P=0.001)是再次术后低钙血症的独立危险因素。结论术前再次手术甲旁减危险度分级与术后PTH值<15pg/ml可预测术后低钙血症的发生。

Objective Hypothyroidism (HypoPT) is one of the most common complications of thyroid reoperation, and hypocalcemia caused by HypoPT is a difficult problem in clinical practice. This study aims to investigate the risk factors for hypocalcemia after reoperation of thyroid cancer. Methods Data of 106 patients who underwent reoperation for thyroid cancer from 2013 to 2018 were retrospectively analyzed. According to the parathyroid area involved in the reoperation, the reoperation was graded: low-risk group, intermediate-risk group and high-risk group. Parathyroid hormone(PTH) and total calcium(Ca) levels were monitored at 12 to 24 hours after surgery. The follow-up period was at least 6 months. The PTH cut-off values of postoperative hypocalcemia were analyzed by ROC curve. The chi-square test and logistic regression analysis were used to analyze the risk factors of postoperative hypocalcemia. Results The incidence of transient HypoPT after reoperation was 35%, and the permanent HypoPT was 1.9%. The grade of reoperation was positively correlated with postoperative HypoPT. The ROC curve showed that the PTH cut-off values of postoperative hypocalcemia was 15 pg/ml and area under curve(AUC) was 0.636(95% CI: 0.530-0.742, P<0.017). Univariate and multivariate analysis showed that reoperation grade and postoperative PTH<15 pg/ml were independent risk factors for postoperative hypocalcemia. Conclusion The grade of reoperation and postoperative PTH value <15 pg/ml can predict postoperative hypocalcemia.