甲状腺切除术后甲状旁腺功能减退的发生情况及相关因素分析

Incidence and Risk Factors of Hypoparathyroidism after Thyroidectomy

目的:探讨甲状腺切除术后甲状旁腺功能减退的发生率及相关危险因素,为临床制定有效的预防干预措施提供依据。方法:选取2019年1月至2020年12月四川省遂宁市中心医院收治的142例行甲状腺切除术患者作为研究对象,收集手术前、后血清甲状旁腺素(parathyroid hormone,PTH)水平值及其他临床资料,计算甲状旁腺功能减退及低钙血症的发生率,进一步根据术后是否发生暂时性甲状旁腺功能减退分为病例组和对照组,采用单因素及多因素Logistic回归模型分析甲状腺切除术后发生暂时性甲状旁腺功能减退的相关危险因素。结果:术后随访6个月,发生甲状旁腺功能减退28例(19.72%),其中有5例(3.52%)为永久性甲状旁腺功能减退、23例(16.20%)为暂时性甲状旁腺功能减退;出现低钙血症者有22例,发生率为15.49%(22/142)。永久性和暂时性甲状旁腺功能减退患者术前PTH、血钙值均处于正常值范围,在术后24 h降至最低,术后6个月逐渐升高,时间主效应均有统计学意义(均P<0.001)。多因素Logistic回归分析显示:合并桥本氏甲状腺炎(OR=3.313)、行甲状腺全切术(OR=1.283)、甲状旁腺误切(OR=1.935)、肿瘤直径大小(OR=2.016)、甲状腺恶性肿瘤(OR=1.723)是甲状腺切除术后发生暂时性甲状旁腺功能减退的独立危险因素(P<0.05)。结论:甲状旁腺功能减退是甲状腺切除术后常见并发症,发生率较高;合并桥本氏甲状腺炎、行甲状腺全切、甲状旁腺误切、肿瘤直径大小、甲状腺恶性肿瘤是甲状腺切除术后发生暂时性甲状旁腺功能减退的独立危险因素。

Objective:To investigate the incidence and risk factors of hypoparathyroidism after thyroidectomy,and provide evidence for making effective preventive and intervention measures in practice.Methods:142 patients who underwent thyroidectomy in Suining Central Hospital from January 2019 to December 2020 were selected as research objects.The levels of serum parathyroid hormone(PTH)before and after operation and other clinical data were collected.The incidences of hypoparathyroidism and hypocalcemia were calculated.Patients were then assign to the case group and the control group according to whether temporary hypoparathyroidism occurred or not after operation.Univariate and multivariate logistic regression models were used to analyze the risk factors of temporary hypoparathyroidism after thyroidectomy.Results:After follow-up for 6 months,28 cases(19.72%)had hypoparathyroidism,of which 5 cases(3.52%)were permanent hypoparathyroidism and 23 cases(16.20%)were temporary hypoparathyroidism;there were 22 cases of hypocalcemia,with the incidence of 15.49%(22/142).The values of PTH and blood calcium in patients with permanent and temporary hypoparathyroidism were in the normal range before operation,decreased to the lowest 24 hours after operation,and gradually increased during the 6 months after operation.The time main effects were statistically significant(all P<0.001).Multivariate logistic regression analysis showed that Hashimoto’s thyroiditis(OR=3.313),total thyroidectomy(OR=1.283),inadvertent parathyroid excision(OR=1.935),tumor diameter(OR=2.016)and thyroid malignancy(OR=1.723)were independent risk factors for temporary hypoparathyroidism after thyroidectomy(P<0.05).Conclusion:Hypoparathyroidism is a common complication after thyroidectomy.Hashimoto’s thyroiditis,total thyroidectomy,inadvertent parathyroid excision,tumor diameter and thyroid malignancy are independent risk factors for temporary hypoparathyroidism after thyroidectomy.