甲状腺手术中甲状旁腺误切的危险因素分析

Risk factors of accidental parathyroidectomy following thyroid surgery

目的探讨甲状腺手术中甲状旁腺误切的危险因素。方法回顾性分析2013年1月至2016年6月期间在四川大学华西医院甲状(旁)腺疾病外科诊疗中心因甲状腺良恶性结节至少行甲状腺全切除的983例患者的临床资料。依据术后病理学检查结果所示的切除标本是否存在整枚或大部分甲状旁腺,将患者分为误切组和非误切组。比较2组患者的临床资料数据,并采用单因素及多因素方法探索甲状旁腺误切的危险因素。结果983例甲状腺疾病患者中,发生甲状旁腺误切50例(误切组),未发生甲状旁腺误切933例(非误切组)。术后暂时性甲状旁腺功能低下发生率:误切组为66.0%(33/50),非误切组为36.2%(338/933),2组比较差异有统计学意义,误切组较高(χ~2=19.903,P<0.05);术后永久性甲状旁腺功能低下发生率:误切组为2.0%(1/50),非误切组为0.4%(4/933),2组比较差异无统计学意义(χ!2=2.315,P=0.128)。单因素分析结果表明,双侧中央区淋巴结清扫(P=0.004)和术中辨认甲状旁腺总数≤2枚(P=0.002)是甲状腺手术中甲状旁腺误切的危险因素;多因素分析结果表明,双侧中央区淋巴结清扫[OR=2.553,95%CI为(1.236,5.277),P=0.011]和术中辨认甲状旁腺总数≤2枚[OR=2.819,95%CI为(1.423,5.581),P=0.003]是甲状腺手术中甲状旁腺误切的独立危险因素。结论甲状腺手术应充分评估患者的获益与风险,合理施行双侧中央区淋巴结清扫。甲状腺手术医师应努力提高对甲状旁腺的辨认能力,从而降低手术中甲状旁腺误切的发生率。

Objective To investigate the risk factors of accidental parathyroidectomy following thyroid surgery.Methods Data of patients who accepted at least total thyroidectomy in the Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases between January 2013 and June 2016 was collected retrospectively. According to the appearance or non-appearance of parathyroid gland in the specimens after pathologic examination, the patients were divided into accidental parathyroidectomy group and non-accidental parathyroidectomy group. Clinical data was collected for comparison between the two groups. The risk factors of accidental parathyroidectomy were indentified with univariate analysis and multivariate analysis. Results A total of 983 patients, 50 patients in the accidental parathyroidectomy group and 933 patients in the non-accidental parathyroidectomy group, were included in the study.Incidence of temporary hypoparathyroidism was 66.0%(33/50) in the accidental parathyroidectomy group and 36.2%(338/933) in the non-accidental parathyroidectomy group,there was significant difference between the two groups(χ~2=19.903, P<0.05). Incidence of permanent hypoparathyroidism was 2.0%(1/50) in the accidental parathyroidectomy group and 0.4%(4/933) in the non-accidental parathyroidectomy group,and there was no significant difference between the two groups(χ~2=2.315, P=0.128). Univariate analysis showed that bilateral central lymph nodes dissection(P=0.004) and the number of identified parathyroid glands ≤2(P=0.002) were risk factors of accidental parathyroidectomy. Multivariate analysis showed that bilateral central lymph nodes dissection [OR=2.553, 95% CI was(1.236, 5.277), P=0.011] and the number of identified parathyroid glands ≤2 [OR=2.819, 95% CI was(1.423, 5.581),P=0.003] were independent risk factors of accidental parathyroidectomy. Conclusions After careful consideration of the possible risks and benefits, bilateral central lymph nodes dissection should be performed rationally. Thyroid surgeons should improve the ability of identification of parathyroid gland to reduce the incidence of accidental parathyroidectomy.