文献类型：期刊文献

中文题名：分化型甲状腺癌患者行甲状腺癌根治术后发生甲状旁腺功能减退的影响因素研究

英文题名：Influencing Factors of Hypoparathyroidism in Patients with Differentiated Thyroid Carcinoma after Radical Thyroidectomy

作者：卢顺利[1,2];于建平[3];李洪涛[2];陈为凯[3];李安东[2];陈超[2];何清远[2];韩晓鹏[2,3]

第一作者：卢顺利

机构：[1]甘肃中医药大学第一临床医学院,甘肃省兰州市730000;[2]中国人民解放军联勤保障部队第九四〇医院普外科,甘肃省兰州市730050;[3]甘肃省中心医院普外科,甘肃省兰州市730070

第一机构：甘肃中医药大学临床医学院

年份：2022

卷号：25

期号：23

起止页码：2869

中文期刊名：中国全科医学

外文期刊名：Chinese General Practice

收录：CSTPCD;;Scopus;北大核心:【北大核心2020】；

基金：甘肃省自然科学基金资助项目(20JR5RA599,21JR11RA172);甘肃省卫生健康行业科研项目(GSWSKY2021-015);甘肃省青年科技基金计划(21JR7RA013)。

语种：中文

中文关键词：分化型甲状腺癌;甲状旁腺功能减退;甲状腺癌根治术;危险因素;影响因素分析;回顾性研究

外文关键词：Differentiated thyroid carcinoma;Hypoparathyroidism;Radical thyroidectomy;Risk factors;Root cause analysis;Retrospective studies

摘要：背景 甲状旁腺功能减退是甲状腺癌根治术常见的并发症之一,尤其目前对于分化型甲状腺癌研究较少。目的 探讨分化型甲状腺癌患者行甲状腺癌根治术后发生甲状旁腺功能减退的影响因素。方法 回顾性选取2018年6月至2020年12月在中国人民解放军联勤保障部队第九四〇医院行甲状腺癌根治术的分化型甲状腺癌患者166例,收集患者的临床资料,包括性别、年龄、体质指数(BMI)、肿瘤部位、肿瘤大小、病灶血供、有无被膜侵犯、手术方式、淋巴结清扫范围、是否使用纳米碳、是否甲状旁腺误切、术前和术后血清甲状旁腺激素(PTH)及血钙水平。结果 166例患者中,术后甲状旁腺功能减退发生率为28.31%(47/166),其中暂时性甲状旁腺功能减退发生率为21.68%(36/166),永久性甲状旁腺功能减退发生率为6.63%(11/166)。甲状旁腺功能正常和甲状旁腺功能减退者性别、年龄、肿瘤部位、有无被膜侵犯、手术方式、淋巴结清扫范围、是否使用纳米碳比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高龄〔OR=1.042,95%CI(1.003,1.083)〕、有被膜侵犯〔OR=2.825,95%CI(1.198,6.659)〕是分化型甲状腺癌患者行甲状腺癌根治术后发生甲状旁腺功能减退的危险因素(P<0.05),达芬奇机器人手术方式〔OR=0.278,95%CI(0.089,0.868)〕、使用纳米碳〔OR=0.374,95%CI(0.144,0.970)〕是分化型甲状腺癌患者行甲状腺癌根治术后发生甲状旁腺功能减退的保护因素(P<0.05)。结论 年龄的增长以及被膜侵犯是分化型甲状腺癌患者行甲状腺癌根治术后发生甲状旁腺功能减退的危险因素,达芬奇机器人手术方式、使用纳米碳有助于降低术后发生甲状旁腺功能减退的风险。
Background Hypoparathyroidism is one of the common complications of radical thyroidectomy,but there are few studies on differentiated thyroid cancer.Objective To investigate the influencing factors of hypoparathyroidism in patients with differentiated thyroid carcinoma after radical thyroidectomy.Methods A total of 166 patients with differentiated thyroid carcinoma who underwent radical thyroidectomy from 940 Hospital of PLA Joint Logistics Support Force from June 2018 to December 2020 were included,and their clinical data were collected,including gender,age,body mass index(BMI),tumor site,tumor size,blood supply of lesion,whether there is capsule invasion,surgical method,scope of lymph node dissection,whether there is use of carbon nanoparticles,parathyroid gland resection.Also,this study monitors preoperative and postoperative serum PTH and follow-up monitoring levels of Ca;.Results Among the 166 patients,the incidence of postoperative hypoparathyroidism was 28.31%(47/166),among which the incidence of temporary hypoparathyroidism was 21.68%(36/166) and the incidence of permanent hypoparathyroidism was 6.63%(11/166).There were statistically significant differences between patients with normal parathyroid function and patients with hypoparathyroidism in gender,age,tumor location,membranous invasion,surgical method,lymph node dissection and the use of carbon nanotube(P<0.05).The results of multivariate Logistic regression analysis showed that advanced age〔OR=1.042,95%CI(1.003,1.083)〕,membranous invasion〔OR=2.825,95%CI(1.198,6.659)〕were risk factors for hypoparathyroidism in patients with differentiated thyroid carcinoma after radical thyroidectomy(P<0.05),Da Vinci robotic surgery〔OR=0.278,95%CI(0.089,0.868)〕and use of carbon nanoscale〔OR=0.374,95%CI(0.144,0.970)〕were protective factors for hypoparathyroidism in patients with differentiated thyroid carcinoma after radical thyroidectomy(P<0.05).Conclusion Aging and capsular invasion are risk factors for hypoparathyroidism in patients with differentiated thyroid carcinoma after radical thyroidectomy.Da Vinci robotic surgery and the use of carbon nanoparticles can help reduce the risk of postoperative hypoparathyroidism.