甲状腺乳头状癌术后甲状旁腺功能减退症影响因素的临床分析

Clinical analysis of the factors influencing hypoparathyroidism after papillary thyroid carcinoma surgery

目的探讨甲状腺乳头状癌(PTC)术后甲状旁腺功能减退症(HPT)的相关因素。方法 回顾性分析200例PTC患者的临床资料,所有患者均行甲状腺全/近全切除和中央区淋巴结清扫治疗。依据术后甲状旁腺功能减退情况分为实验组(甲状旁腺功能减退, 72例)和对照组(甲状旁腺功能正常, 128例)。分析PTC术后HPT的影响因素及永久性和暂时性HPT的影响因素。结果 200例患者经甲状旁腺激素(PTH)血钙水平检测,共72例患者发生HPT,发生率为36.0%,其中5例为永久性HPT,67例为暂时性HPT。两组患者的年龄、手术范围、有无被膜侵犯、有无自体移植、Ⅵ区淋巴结双侧清扫比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,手术范围、被膜侵犯、Ⅵ区淋巴结双侧清扫是术后HPT的独立危险因素(P<0.05)。永久性和暂时性HPT患者的Ⅵ区淋巴结清扫与手术范围的比较差异有统计学意义(P<0.05)。结论 HPT是甲状腺手术常见的术后并发症,其中被膜侵犯、手术范围、Ⅵ区淋巴结清扫是PTC术后HPT独立的危险因素。

Objective To discuss the factors influencing hypoparathyroidism(HPT) after papillary thyroid carcinoma(PTC) surgery. Methods The clinical data of 200 patients with PTC were retrospectively analyzed, and all patients were treated with total/near-total thyroidectomy and lymph node dissection in the central region. According to the postoperative hypoparathyroidism, they were divided into experimental group(hypoparathyroidism, 72 cases) and control group(normal parathyroid function, 128 cases) factors influencing postoperative HPT and permanent and temporary HPT after PTC were analyzed. Results By Parathyroid hormone and blood calcium detection, 72 of 200 patients had HPT, the incidence rate was 36.0%, of which 5 cases were permanent HPT and 67 cases were temporary HPT. There were statistically significant differences in age, extent of surgery, presence or absence of capsule invasion, presence or absence of autograft, and bilateral level Ⅵlymph node dissection between the two groups(P<0.05). Multi-factor Logistic regression analysis showed that the extent of surgery, capsule invasion, and bilateral level Ⅵ lymph node dissection were independent risk factors for postoperative HPT(P<0.05). There was a statistically significant difference between permanent and temporary HPT patients in bilateral level Ⅵ lymph node dissection and the extent of surgery(P<0.05). Conclusion HPT is a common postoperative complication of thyroid surgery, among which capsule invasion, surgical methods, and bilateral level Ⅵ lymph node dissection are independent risk factors for HPT after PTC.