腔镜甲状腺切除术后甲状旁腺功能减退的影响因素分析及防治策略

Influencing factors and prevention strategies of hypoparathyroidism after endoscopic thyroidectomy

目的探讨腔镜甲状腺切除术后甲状旁腺功能减退的影响因素及防治策略。方法回顾性分析南方医科大学珠江医院2021年1月至2022年1月收治的135例行腔镜甲状腺手术患者围手术期及术后资料,分析术前、术后1个月血清钙及甲状旁腺激素(PTH)变化趋势,并采用多因素Logistic回归分析甲状旁腺功能减退的影响因素。结果135例患者中非甲状旁腺功能减退者93例(A组),甲状旁腺功能减退者42例,其中生化甲状旁腺功能减退15例(B组),临床甲状旁腺功能减退27例(C组);暂时性甲状旁腺功能减退39例,永久性甲状旁腺功能减退3例。相对于术前,术后24 h三组PTH的下降幅度分别为35%(A组)、63%(B组)和85%(C组),血钙浓度的下降幅度分别为4%、10%和19%,差异均有统计学意义(F=90.57、84.77,均P<0.001)。相对于术前,术后1个月三组PTH分别下降9%、21%、44%;血钙浓度A组上升6%,B组上升4%、C组下降4%,差异均有统计学意义(F=9.99、4.38,P<0.001、0.017)。多因素Logistic回归分析发现,甲状腺切除范围(OR=27.53,95%CI:7.74~97.93,P<0.001)、淋巴结清扫(OR=5.87,95%CI:1.15~29.89,P=0.033)是腔镜甲状腺切除术后发生甲状旁腺功能减退的危险因素。结论甲状腺切除范围、淋巴结清扫是腔镜甲状腺切除术后甲状旁腺功能减退的影响因素,术后1个月仍需要复查评估甲状旁腺功能。

Objective To investigate the influencing factors and prevention strategies of hypoparathyroidism after endoscopic thyroidectomy.Methods The perioperative and postoperative data of 135 patients with thyroid diseases treated by endoscopic surgery in Zhujiang Hospital,Southern Medical University from January 2021 to January 2022 were retrospectively reviewed.The trends of serum calcium and parathyroid hormone(PTH)before operation and 1 month after operation were analyzed,and the influencing factors of hypoparathyroidism were analyzed by multivariate Logistic regression analysis.Results Among the 135 patients,93 were non-hypothyroidism(group A)and 42 were hypothyroidism,15 of them were biochemical hypothyroidism(group B)and 27 were clinical hypothyroidism(group C).Among the 42 patients with hypothyroidism,39 patients had temporary hypothyroidism and 3 patients had permanent hypothyroidism.The decrease of PTH and serum calcium concentration in group A was 35%and 4%;63%and 10%in Group B;85%and 19%in Group C,and the differences were statistically significant(F=90.57,84.77;both P<0.001).Compared with the first day after operation,results on 1 month after operation PTH and blood calcium concentration levels were recovered to a certain extent.Compared with preoperative results,PTH was decreased by 9%,21%,44%in group A,group B,group C,respectively,and blood calcium concentration increased by 6%in group A,4%in group B and decreased by 4%in group C,with statistically significant differences(F=9.99,4.38;P<0.001,0.017).Multivariate Logistic regression analysis found that thyroidectomy scope(OR=27.53,95%CI:7.74-97.93,P<0.001),lymph node dissection(OR=5.87,95%CI:1.15-29.89,P=0.033)were risk factors for hypoparathyroidism after endoscopic thyroidectomy.Conclusions Thyroidectomy scope and lymph node dissection are the influencing factors of hypoparathyroidism.The function of parathyroid is still needed for the assessment 1 month after surgery.