摘要
目的探讨并分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者根治术后发生甲状旁腺功能损伤的危险因素。方法对河南省肿瘤医院头颈甲状腺外科2019年1月至2020年1月期间行PTC根治术的192例患者进行回顾性分析。对影响术后低血钙及低甲状旁腺激素(parathyroid hormone,PTH)的危险因素运用χ^(2)检验和二分类logistic回归进行统计学分析。结果192例患者中甲状旁腺功能正常或低下者所占比例分别为62.5%(120/192)和37.5%(72/192)。单因素分析结果表明:患者有并发症、合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)、甲状腺全切除、N1a分期、Ⅵ区淋巴结清扫和无甲状旁腺种植是PTC术后甲状旁腺功能损伤的危险因素(P<0.05)。进一步行二分类logistic回归分析结果显示:(1)合并HT、N1a分期和行Ⅵ区淋巴结清扫是PTC术后低血钙的独立危险因素,未合并HT的OR=0.313、95%CI为(0.129,0.760)、P=0.010,N1a分期的OR=3.457、95%CI为(1.637,7.301)、P=0.001,无Ⅵ区淋巴结清扫的OR=0.115、95%CI为(0.041,0.323)、P<0.001。(2)合并HT、N1a分期、行Ⅵ区淋巴结清扫和无甲状旁腺种植是PTC术后低PTH的独立危险因素,未合并HT的OR=0.285、95%CI为(0.117,0.698)、P=0.006,N1a分期的OR=3.747、95%CI为(1.762,7.968)、P=0.001,无Ⅵ区淋巴结清扫的OR=0.112、95%CI为(0.039,0.317)、P<0.010,有甲状旁腺种植的OR=0.464、95%CI为(0.221,0.978)、P=0.043。结论合并HT、N1a分期、Ⅵ区淋巴结清扫和无甲状旁腺种植是PTC患者术后发生甲状旁腺功能损伤的主要危险因素。
Objective To investigate the risk factors for hypoparathyroidism following radical surgery for patients with thyroid papillary carcinoma(PTC).Methods A retrospective analysis was made on 192 patients with PTC who underwent radical thyroidectomy in the Department of Head Neck and Thyroid Surgery of Henan Cancer Hospital from January 2019 to January 2020.There were 52 males and 140 females with a median age of 48 years.The risk factors of hypocalcemia and hypoparathyroidism syndrome were screened by χ^(2) test and binary logistic regression analysis.Results In 192 patients the proportion of patients with normal or hypoparathyroidism after operation were 62.5%(120/192)and 37.5%(72/192),respectively.Univariate analysis showed that complications,Hashimoto’s thyroiditis(HT),total thyroidectomy,N1 a staging,Ⅵlymph node dissection and parathyroid not planted were risk factors for postoperative hypoparathyroidism in patients with PTC.Binary logistic regression analysis showed that:(1)HT,N1 a staging andⅥlymph node dissection were independent risk factors for postoperative hypocalcemia[without HT:OR=0.313,95%CI(0.129,0.760),P=0.010;N1 a staging:OR=3.457,95%CI(1.637,7.301),P=0.001;withoutⅥlymph node dissection:OR=0.115,95%CI(0.041,0.323),P<0.001].(2)HT,N1 a staging,Ⅵlymph node dissection and parathyroid not planted were independent risk factors for postoperative low parathyroid hormone[without HT:OR=0.285,95%CI(0.117,0.698),P=0.006;N1 a staging:OR=3.747,95%CI(1.762,7.968),P=0.001;withoutⅥlymph node dissection:OR=0.112,95%CI(0.039,0.317),P<0.010;planted parathyroid:OR=0.464,95%CI(0.221,0.978),P=0.043].Conclusion HT,N1 a staging,Ⅵlymph node dissection and parathyroid not planted are vital risk factors for hypoparathyroidism in patients with PTC after radical thyroidectomy.
作者
杜伟
范杰
张晓军
冯露
DU Wei;FAN Jie;ZHANG Xiaojun;FENG Lu(Department of Head Neck and Thyroid Surgery,Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450008,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2021年第7期878-883,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
河南省科技厅科技攻关项目(项目编号:182102310382)。
