全甲状腺切除术后甲状旁腺功能低下相关危险因素分析

目的探讨全甲状腺切除术后甲状旁腺功能低下相关危险因素，提出相应对策。方法选择肿瘤外科2011至2014年行全甲状腺切除术的患者220例，采用SPSS16.0软件分析患者术后甲状旁腺功能低下与相关临床指标的关系。结果220例全甲状腺切除术患者术后发生甲状旁腺功能低下者141例，发生率为64.1%；140例患者在6个月内甲状旁腺功能恢复正常，另1例遗留永久性低钙血症。单因素分析显示，全甲状腺切除术后甲状旁腺功能低下发生与患者行淋巴结清扫、患桥本甲状腺炎、甲状旁腺损伤以及术前维生素D水平低下有关。多因素logistic回归分析提示行淋巴结清扫术以及术中甲状旁腺损伤是术后甲状旁腺功能低下发生的独立危险因素。结论全甲状腺切除术中，正确识别甲状旁腺，精细化操作，完整保留甲状旁腺血供，是避免全甲状腺切除术后永久性低钙血症的最有效方法。

Risk factors of postoperative hypoparathyroidism after total thyroidectomy

Objective To investigate the risk factors of postoperative hypoparathyroidism after total thyroidectomy. Methods Two hundred and twenty patients undergoing total thyroidectomy in our hospital during 2011 to 2014 were included in the study. The relationship between hypoparathyroidism and related clinical index were analyzed by SPSS 16.0 statistical software. Results In this group 141 patients suffered postoperative hypoparathyroidism after total thyroidectomy with an incidence rate of 64.1% , among whom only 1 case was permanent hypoparathyroidism and rest 140 cases were temporary hypoparathyroidism. Univariate analysis showed that postoperative hypoparathyroidism was related to lymph node dissection, Hashimoto''s thyroiditis, parathyroid damage and preoperative serum vitamin D levels. Logistic multivariate analysis showed that lymph node dissection and intraoperative parathyroid damage were the independent risk factors of postoperative hypoparathy- roidism. Conclusion Parathyroid protection during the operation is the most effective way to avoid permanent hypocalcemia after total thyroidectomy.