论著

甲状腺全切术后早期低钙血症发生的影响因素分析

中华普外科手术学杂志(电子版),2021, 15 (01): 77-79.
目的

探讨甲状腺全切除术后早期低钙血症的危险因素。

方法

选取2016年1月到2019年6月因甲状腺癌行甲状腺全切除术的715例患者病例进行回顾性研究。采用SPSS 24.0软件进行分析,影响术后血钙水平单因素差异比较采用χ2检验、t检验或非参数检验,Logistic模型进行多因素分析。以P<0.05为差异有统计学意义。

结果

术后低钙血症297例(41.5%),其中228例(76.8%)诊断为无症状低钙血症,69例(23.2%)出现临床症状。其中性别、体重指数(BMI)、术后第1天血清钙、术后第1天PTH、术后第3天PTH、癌灶数量、CLND数量及范围是术后早期发生低钙血症的危险因素(P<0.05)。在多变量分析中,性别( P=0.003)、BMI(P=0.005)、CLND清扫范围(P=0.019)、术后第1天PTH(P= 0.033)、癌灶数量(P=0.011)是独立危险因素。

结论

女性、低体重、行单侧或双侧中央区淋巴结清扫、术后第1天PTH明显下降、癌灶数量两个以上是早期发生低钙血症的独立危险因素。

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甲状腺手术作为甲状腺恶性肿瘤的最终治疗选择,其中早期低钙血症(early hypocalcemia, EH)是甲状腺全切术(total thyroidectomy, TT)后比较常见的并发症,有时很难纠正。尽管随着甲状旁腺保护技术的发展,低钙血症发生率有所下降,但在接受TT的患者中,短暂性早期低钙血症发生率可达6.9%~49.0%[1]。TT后永久性低钙血症发生率可达3%[2]。术者对甲状腺手术后低钙血症的预测能力对术后处理非常重要。早期发觉EH的风险将可以消除不必要的实验室检查。在这项研究中,我们分析了与患者相关的因素以及手术方法,以发现它们与EH发展之间的显著相关性。

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贡献者信息

李新喜

830054 乌鲁木齐,新疆医科大学第一附属医院 血管甲状腺外科

依地热斯·艾山

830054 乌鲁木齐,新疆医科大学第一附属医院 血管甲状腺外科

田野

830054 乌鲁木齐,新疆医科大学第一附属医院 血管甲状腺外科

张磊

830054 乌鲁木齐,新疆医科大学第一附属医院 血管甲状腺外科

罗军

830054 乌鲁木齐,新疆医科大学第一附属医院 血管甲状腺外科

通信作者

罗军

830054 乌鲁木齐,新疆医科大学第一附属医院 血管甲状腺外科

Email:chinese1018@126.com

关键词

低钙血症;甲状腺切除术;预测

基金项目

新疆维吾尔自治区卫生计生委青年医学科技人才专项 (WJWY-201846)

作者声明

本文引用格式:李新喜,依地热斯·艾山,田野,等.甲状腺全切术后早期低钙血症发生的影响因素分析[J/CD].中华普外科手术学杂志(电子版),2021,15(1):77-79.

历史

出版日期:2021-02-26

收稿日期:2020-06-04

Original Article
Clinical analysis of risk factors of early hypocalcemia after total thyroidectomy
Li Xinxi,  Yidiresi· Aishan,  Tian Ye,  Zhang Lei,  Luo Jun
Published on 2021-02-26
Cite as Chin J Oper Proc Gen Surg(Electronic Edition), 2021,15(01): 77-79. DOI: 10.3877/cma.j.issn.1674-3946.2021.01.022
Abstract
Objective

To investigate the risk factors of early hypocalcemia after total thyroidectomy.

Methods

A retrospective study was conducted in 715 patients who underwent total thyroidectomy for thyroid cancer from January 2016 to June 2019. Statistical analysis were performed by using SPSS 24.0 software. Risk factors of early hypocalcemia were analyzed by using chi-square test, t test or nonparametric test. Logistic model were employed for multiple factors analysis. A P value of <0.05 was considered as statistically significant difference.

Results

There were 297 cases (41.5%) of postoperative hypocalcemia, including 228 cases (76.8%) of asymptomatic hypocalcemia, and 69 cases (23.2%) with clinical symptoms. Among them, gender, BMI (body mass index), serum calcium on the 1st day after surgery, PTH on the 1st day after surgery, PTH on the 3rd day after surgery, number of cancer lesions, number and range of CLND were risk factors for early postoperative hypocalcemia (P<0.05). In the multivariate analysis, gender (P=0.003), BMI (P=0.005), CLND sweep range (P=0.019), PTH on the 1st day after surgery (P=0.033), and number of cancer lesions (P=0.011) were independent risk factors.

Conclusion

Women, low body weight, unilateral or bilateral central lymph node dissection, significant decrease of PTH on the first day after surgery, and more than two cancer lesions are independent risk factors for early hypocalcemia.

Key words:

Hypocalcemia; Thyroidectomy; Forecasting

Contributor Information
Li Xinxi

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital Xinjiang Medical University, Urumqi 830054, China

Yidiresi· Aishan

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital Xinjiang Medical University, Urumqi 830054, China

Tian Ye

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital Xinjiang Medical University, Urumqi 830054, China

Zhang Lei

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital Xinjiang Medical University, Urumqi 830054, China

Luo Jun

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital Xinjiang Medical University, Urumqi 830054, China