甲状腺乳头状癌术后甲状旁腺功能减退发生情况及严重程度的相关风险分析

An analysis of risk factors for the occurrence and severity of hypoparathyroidism after surgery for papillary thyroid carcinoma

目的分析甲状腺乳头状癌术后甲状旁腺功能减退及严重程度的相关风险。方法回顾性分析194例诊断为甲状腺乳头状癌并行甲状腺全切及中央区淋巴结清扫手术患者的临床资料。依据术后第1天的血清甲状旁腺激素(PTH)水平分为甲状旁腺功能减退组(PTH<12 pg/mL,118例)和甲状旁腺功能正常组(PTH≥12 pg/mL,76例)。分析甲状旁腺功能减退及严重程度的相关风险因素。结果 194例患者中,118例(60.8%)患者术后发生甲状旁腺功能减退。单因素分析显示,肿瘤位于后背膜、双侧中央区淋巴结清扫、淋巴结清扫数量≥10个、合并桥本甲状腺炎、术前降钙素高表达和术后引流量多与甲状腺乳头状癌术后甲状旁腺功能减退有关(P<0.05)。多因素分析结果显示,肿瘤位于后背膜和合并桥本甲状腺炎是患者术后甲状旁腺功能减退的独立危险因素(P<0.05)。118例发生甲状旁腺功能减退患者中,轻度减退35例(5 pg/mL≤PTH<12 pg/mL),重度减退83例(0 pg/mL≤PTH<5 pg/mL)。高血压和术前血清高PTH是患者术后重度甲状旁腺功能减退的危险因素(P<0.05)。结论甲状腺肿瘤位于后背膜和合并桥本甲状腺炎可能增加甲状腺乳头状癌患者甲状腺全切术后甲状旁腺功能减退的发生;其中,高血压及术前血清高PTH患者可能发生重度甲状旁腺功能减退。

Objective To analyze the relevant risk factors for the occurrence and severity of hypoparathyroidism after surgery for papillary thyroid carcinoma.Methods The clinical data of 194 patients diagnosed with papillary thyroid carcinoma and underwent total thyroidectomy and lymph node dissection were retrospectively analyzed.According to serum level of parathyroid hormone(PTH) on the first postoperative day, the patients were divided into two groups of A(with hypoparathyroidism, PTH<12 pg/mL,118 cases) and B(with normal parathyroid function, PTH≥12 pg/mL,76 cases).The relevant risk factors for the occurrence and severity of hypoparathyroidism after surgery for papillary thyroid carcinoma were analyzed.Results Of 194 patients, 118(60.8%) patients had postoperative hypoparathyroidism.Univariate analysis showed that the tumor located in the posterior dorsal membrane, bilateral central lymph node dissection, lymph node dissection number ≥10,combined with Hashimoto’s thyroiditis, high expression of calcitonin before surgery and more drainage after surgery were the factors related to postoperative hypoparathyroidism(P<0.05).Multivariate analysis showed that the tumor located in the posterior dorsal membrane and Hashimoto’s thyroiditis were the independent risk factors for postoperative hypoparathyroidism(P<0.05).Of 118 patients with hypoparathyroidism, 35 patients had mild hypoparathyroidism(5 pg/mL≤PTH<12 pg/mL) and 83 cases had severe hypoparathyroidism(0 pg/mL≤PTH<5 pg/mL).Hypertension and high preoperative PTH were the risk factors for severe postoperative hypoparathyroidism(P<0.05).Conclusion The tumor located in the posterior dorsum and Hashimoto’s thyroiditis may increase the incidence of hypoparathyroidism in the patients with papillary thyroid cancer after total thyroidectomy, of whom the patients with hypertension and high preoperative serum PTH may develop a severe hypoparathyroidism.