甲状腺全切术后甲状旁腺功能降低的原因及补钙疗效分析

目的分析甲状腺全切术后甲状旁腺功能降低的原因及补钙治疗的效果。方法回顾性分析80例行甲状腺全切术病人临床资料，根据病人是否进行预防性补钙治疗分为治疗组，各40例。比较2组病人术前、术后1周及术后1个月甲状旁腺激素(PTH)和Ca2+水平；比较2组病人PTH恢复时间、Ca2+恢复时间、低钙血症消失时间、低钙血症发生率、转永久性低钙血症发生率。对观察组中出现甲状旁腺功能减退及未减退的病人进行单因素分析，将有差异的影响因素纳入logistic回归模型分析病人甲状旁腺功能减退的危险因素。结果2组病人PTH、Ca2+水平术后1周、术后1个月、术前逐渐降低，差异有统计学意义(P < 0.01)；治疗组术后1周、术后1个月PTH和Ca2+水平高于观察组(P < 0.05~P < 0.01)。治疗组PTH恢复时间、Ca2+恢复时间、低钙血症消失时间、低钙血症发生率低于观察组(P < 0.05~P < 0.01)。甲状旁腺功能减退病人病理类型为恶性、手术入路从外向内、肿瘤≥4 cm、肿瘤位置在后背膜、淋巴结清扫、甲状旁腺误切、应用纳米碳示踪剂比例高于甲状旁腺功能未减退病人(P < 0.05~P < 0.01)。logistic回归性分析显示，病理类型为恶性、手术入路从外向内、肿瘤大小≥4 cm、肿瘤位置在后背膜、淋巴结清扫、甲状旁腺误切、应用纳米碳示踪剂是甲状腺全切术后病人甲状旁腺功能减退的危险因素(P < 0.05~P < 0.01)。结论甲状旁腺减退受多种因素影响，应进行预防性补钙。

Analysis of the causes of hypoparathyroidism after total thyroidectomy and treatment of calcium supplement

ObjectiveTo analyze the causes of hypoparathyroidism after total thyroidectomy and effects of calcium supplement.MethodsThe clinical data of 80 cases treated with total thyroidectomy were retrospectively analyzed.According to the treatment with or without calcium supplement, the patients were divided into the treatment group and observation group (40 cases in each group).The levels of parathyriod hormone(PTH) and Ca2+ between two groups were compared before and after 1 month and 1 week of operation.The PTH recovery time, Ca2+ recovery time, disappearance time of hypocalcemia, incidence rate of hypocalcemia and incidence rate of permanent hypocalcemia were compared between two groups.The patients with and without hypoparathyroidism in observation group were evaluated using single factor analysis.The factors with significant difference were included in the logistic regression analysis model to identify the risk factors of hypoparathyroidism.ResultsThe levels of PTH and Ca2+ in two groups after 1 month and 1 week of operation, and before operation gradually decreased, and the difference of which was statistically significant(P < 0.01).The levels of PTH and Ca2+ in treatment group after 1 month and 1 week of operation and before operation were significantly higher than those in observation group(P < 0.05 to P < 0.01).The PTH recovery time, Ca2+ recovery time, hypocalcemia disappearance time and hypocalcemia incidence in treatment group were significantly lower than those in observation group(P < 0.05 to P < 0.01).The proportions of hypoparathyroidism patients with malignant pathological type, from outside to inside surgical approach, tumor ≥4 cm, tumor locating the back membrane, lymph node cleaning, parathyroid gland miss cutting and using nano carbon tracer were significantly higher than those of the patients without hypoparathyroidism(P < 0.05 to P < 0.01).The results of logistic regression analysis showed that the malignant pathological type, from outside to inside surgical approach, tumor ≥4 cm, tumor locating the back membrane, lymph node cleaning, parathyroid gland miss cutting and using nano carbon tracer were the risk factors of hypoparathyroidism after total thyroidectomy(P < 0.05 to P < 0.01).ConclusionsThe hypoparathyroidism is affected by many factors, so the preventive calcium supplement should be performed.