甲状腺肿瘤患者术后甲状旁腺功能减退的影响因素分析

Analysis of Influencing Factors of Postoperative Hypoparathyroidism in Patients with Thyroid Tumor

目的 探索甲状腺肿瘤患者术后甲状旁腺功能减退的影响因素。方法 回顾性分析2016年1月至2019年12月于枣庄矿业集团中心医院住院接受手术治疗的628例甲状腺肿瘤患者临床资料,按照术后甲状旁腺激素(PTH)水平分为PTH降低组(114例)和PTH正常组(514例),并分析两组性别、年龄、肿瘤病理类型、肿瘤大小、淋巴结转移数目、手术术式、术后并发症以及术后血清钙离子检出值的差异,评估影响甲状腺术后甲状旁腺功能减退的因素。结果 甲状腺肿瘤患者术后PTH水平降低发生率为18.2%(114/628);单因素分析结果显示:年龄、病理类型、肿瘤大小、淋巴结转移数目、手术方式、术后并发症以及术后血清钙离子检出值与术后患者PTH水平降低相关(P<0.05);多因素Logistic回归分析结果显示病理类型(P=0.042)和手术方式(P=0.008)是影响甲状腺术后甲状旁腺功能减退的独立危险因素;对病理分型进行二元Logistic回归分析的结果显示,滤泡状腺癌、未分化癌和髓样癌对患者PTH水平降低有影响,其他病理分型均无影响;对不同手术方式进行二元Logistic回归分析结果显示,A术式对术后患者PTH水平降低有负向影响(P<0.05),C术式对术后患者PTH水平降低无影响(P>0.05),B、D和E术式对术后患者PTH水平降低有影响(P<0.05)。结论 影响甲状腺肿瘤患者术后PTH水平下降的风险因素为病理类型和手术术式,其中行B、D和E术式的患者术后PTH水平下降风险较高,术后护理应注意监测血钙水平,以降低术后PTH水平下降的发生率。

Objective The influencing factors of postoperative hypoparathyroidism in patients with thyroid tumors were explored. Methods With retrospective analysis of clinical data of 628 patients with thyroid tumors hospitalized for surgical treatment in Central Hospital of Zaozhuang Mining Group from January 2016 to December 2019, the patients were divided into the PTH reduced group(114 cases) and the PTH normal group(514 cases), according to the postoperative parathyroid hormone(PTH) level. Meanwhile, the differences between the two groups in gender, age, tumor pathological type, tumor size, number of lymph node metastases, surgical methods, postoperative complications and postoperative serum calcium detection value were analyzed, and the factors affecting postoperative hypoparathyroidism were evaluated. Results The incidence of postoperative PTH reduction in patients with thyroid tumors was 18.2%(114/628);The results of univariate analysis showed that age, pathological type,tumor size, number of lymph node metastasis, operation mode, postoperative complications and serum calcium level were related to the decrease of PTH level(P<0.05);Multivariate logistic regression analysis showed that pathological type(P=0.042) and surgical method(P=0.008)were independent risk factors for hypoparathyroidism after thyroid surgery;The results of binary logistic regression analysis for pathological classification showed that follicular adenocarcinoma, undifferentiated carcinoma and medullary carcinoma had effect on the decrease of PTH level, while other pathological classifications had no effect;The results of binary logistic regression analysis for different operation methods showed that operation type A had a negative effect on the postoperative PTH level(P<0.05), operation type C had no effect on the postoperative PTH level(P > 0.05), and operation types B, D and E had an effect on the postoperative PTH level(P<0.05). Conclusions With pathological types and surgical procedures as risk factors affecting the decrease of PTH level in patients with thyroid tumors after surgery, patients with B, D and E surgical procedures have a higher risk of PTH level decrease. Postoperative nursing should pay attention to monitoring the blood calcium level to reduce the incidence of PTH decline.