甲状腺癌术后甲状旁腺功能减退相关因素分析

Related factors of hypoparathyroidism after thyroid cancer surgery

目的分析甲状腺癌术后甲状旁腺功能减退(hypoparathyroidism,HPT)的相关危险因素。方法回顾性分析电子科技大学医学院附属肿瘤医院头颈外科一病区2021年1月至2021年12月因甲状腺癌行甲状腺全切(total thyroidectomy,TT)及中央区淋巴结清扫(central lymph node dissection,CLND)的430例患者的临床资料,根据术后第1天和术后6个月的甲状旁腺激素(parathyroid hormone,PTH)水平,分为暂时性甲状旁腺功能减退(transient hypoparathyroidis,tHPT)组174例、永久性甲状旁腺功能减退(permanent hypoparathy roidism,pHPT)组11例,并以同期甲状旁腺功能正常患者作为对照组(其中术后第1天256例、术后6个月419例)。观察指标为:性别、年龄、体重指数、肿瘤最大直径、外侵、CLND、甲状旁腺自体移植(parathyroid autotransplantation,PA)、合并桥本氏甲状腺炎(Hashimoto's thyroiditis,HT)、颈侧区淋巴结清扫(lymph node dissection,LND)情况,运用χ^(2)检验及多因素Logistic回归分析,对HPT的可疑危险因素进行评估。结果单因素分析显示,女性[(86.21%)vs(77.34%),χ^(2)=5.73,P=0.022]、PA[(44.83%)vs(28.91%),χ^(2)=11.49,P=0.001]与术后tHPT的发生有关;肿瘤侵犯后被膜[(81.82%)vs(45.11%),χ^(2)=5.81,P=0.016]与术后pHPT的发生有关。多因素分析发现,术后tHPT的独立危险因素是女性(P=0.028,OR=1.870)、肿瘤最大直径(P=0.043,0R=1.595)、外侵(P=0.018,0R=1.587)、PA(P=0.001,OR=1.966)。pHPT的独立危险因素是肿瘤侵犯后被膜(P=0.046,OR=4.658)。结论女性、肿瘤最大直径、外侵、PA是TT术后tHPT的独立危险因素。肿瘤侵及后被膜是甲状腺术后pHPT的独立危险因素.

Objective To analyze the risk factors of hypoparathyroidism after thyroid cancer surgery.Methods The clinical data of 430 patients who underwent total thyroidectomy and central lymph node dissection due to thyroid cancer from Jan.2021 to Dec.2021 in the First Ward of Head and Neck Surgery of Sichuan Cancer Hospital were collected.They were divided into two groups according to their parathyroid hormone levels at day 1 and 6 months after surgery:temporary hypoparathyroidism group(n=174)and permanent hypoparathyroidism group(n=11).and patients with normal parathyroid function were selected as control group(256 cases on postop-erative day 1 and 419 cases on postoperative month 6).Gender,age,body mass index,tumor diameter,invasion,central lymph node dissection,parathyroid transplantation,Hashimoto's thyroiditis,and lymph node dissection in lateral neck region were monitored.The suspicious risk factors of hypoparathyroidism were evaluated by χ^(2)test and multivariate logistic regression analysis.Results Univariate analysis showed that women(86.21%vs 77.34%,χ^(2)=5.73,P=0.022)and parathyroid autotransplantation(44.83% vs 28.91%,χ^(2)=11.49,P=0.001)were associated with postoperative transient hypoparathyroidism.The posterior capsule of tumor invasion(81.82%vs 45.11%,χ^(2)=5.81,P=0.016)was associated with postoperative hypoparathyroidism.Multivariate analysis showed that the independent risk factors of transient hypoparathyroidism were female(P=0.028,OR=1.870),the largest diameter of tumor(P=0.043,OR=1.595),extravasation of tumor(P=0.018,OR=1.587),and parathyroid transplantation(P=0.001,OR=1.966).The independent risk factor of permanent parathyroidism was the posterior capsule of tumor invasion(P=0.046,OR=4.658).Conclusions Female,the largest tumor diameter,tumor invasion and parathyroid transplantation are independent risk factors for transient hypoparathyroidism after total thyroidectomy.The posterior capsule of tumor invasion is an independent risk factor for permanent hypoparathyroidism after total thyroidectomy.