甲状腺乳头状癌根治术后低钙血症发生状况及其影响因素

Occurrence and influencing factors of hypocalcemia after radical surgery for papillary thyroid carcinoma

目的研究甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)根治术后低钙血症(Symptomatic hypocalcemia,SH)发生状况及其影响因素。方法回顾性分析天津市公安医院于2020年1月-2023年1月纳入的55例行PTC根治术患者的临床资料,根据是否术后发生SH进行分组,采用Logistic回归分析SH发生的影响因素。结果55例行PTC根治术患者中术后发生SH共17例。经单因素分析,BMI、手术方式、是否进行手术清扫、手术时间及是否预防性使用钙剂与术后发生SH有关,两组差异有统计学意义(P<0.05)。多因素分析显示,较长的手术时间、进行手术清扫、双侧腺叶手术为术后发生SH的危险因素(P<0.05),而较大的BMI、预防性使用钙剂则是术后发生SH的保护因素(P<0.05)。结论PTC根治术后患者SH的发生受到多种因素影响。在确保肿瘤控制的同时,可采取术前适当增加患者BMI、尽量缩短手术时间、合理制定淋巴结清扫方案、术前预防性补充钙剂等措施来减少术后SH的发生。

Objective To investigate the occurrence and influencing factors of Symptomatic hypocalcemia(SH)after radical surgery of Papillary thyroid carcinoma(PTC).Methods The clinical data of 55 patients undergoing radical PTC operation in our hospital from January 2020 to January 2023 were retrospectively analyzed.The patients were grouped according to whether SH occurred after surgery,and the influencing factors of SH occurrence were analyzed by Logistic regression.Results There were 17 cases of SH in 55 patients who underwent PTC radical operation.Through univariate analysis,BMI,operation method,whether to carry out surgical dissection,operation time and whether to use calcium prophylactically were related to the occurrence of SH after operation,and the difference between the two groups was statistically significant(P<0.05).Multifactor analysis showed that longer operation time,surgical clearance and bilateral glandular lobe operation were risk factors for SH after operation(P<0.05),while larger BMI and prophylactic calcium were protective factors for SH after operation(P<0.05).Conclusion The occurrence of SH after radical PTC operation is influenced by many factors.At the same time to ensure the control of tumor,we can take measures to strengthen the patient's body before surgery,shorten the operation time as much as possible,make a reasonable lymph node dissection plan,and take preventive calcium supplement before surgery to reduce the occurrence of SH after surgery.