中华内分泌外科杂志
中華內分泌外科雜誌
중화내분비외과잡지
CHINESE JOURNAL OF ENDOCRINE SURGERY
2015年
3期
238-241
,共4页
鄢丹桂%张彬%徐震纲%唐平章
鄢丹桂%張彬%徐震綱%唐平章
언단계%장빈%서진강%당평장
甲状腺肿瘤%癌%甲状腺切除术%低钙血症%甲状腺旁腺功能减退症
甲狀腺腫瘤%癌%甲狀腺切除術%低鈣血癥%甲狀腺徬腺功能減退癥
갑상선종류%암%갑상선절제술%저개혈증%갑상선방선공능감퇴증
Thyroid neoplasms%Carcinoma%Thyroidectomy%Hypocalcemia%Hypoparathyroidism
目的：探讨甲状腺癌甲状腺全切除术后低钙血症的影响因素。方法回顾性分析中国医学科学院肿瘤医院2009年6月至2011年12月650例甲状腺癌甲状腺全切术患者临床资料，研究年龄、性别、原发灶分期、原发灶是否初治、颈淋巴清扫、气管食管沟淋巴清扫、甲状旁腺意外切除（ inadvertent parathyroidectomy，IPE）和采用精细被膜解剖技术与术后持续性低钙血症关系。影响术后血钙水平单因素差异比较采用χ2检验，Logistic模型进行多因素分析。结果650例中17.2％（112／650）出现持续性低钙血症。原发灶晚期（OR＝2.121，95％CI为1.140～3.947，P＝0.018）、双侧气管食管沟淋巴清扫（OR＝1.852，95％CI为1.199～2.863，P＝0.006）、未采用精细被膜解剖技术（OR＝2.307，95％CI为1.208～4.405，P＝0.011）、IPE（OR＝1.580，95％CI为1.029～2.427，P＝0.037）是甲状腺全切除术后长期低钙的独立危险因素。结论局部晚期甲状腺癌行甲状腺全切除术后长期低钙发生率较高。采用精细被膜解剖技术、严格掌握双侧气管食管淋巴清扫指征、熟悉甲状旁腺解剖，减少甲状旁腺误切，能降低术后持续性低钙血症发生率，改善甲状腺癌患者生活质量。
目的：探討甲狀腺癌甲狀腺全切除術後低鈣血癥的影響因素。方法迴顧性分析中國醫學科學院腫瘤醫院2009年6月至2011年12月650例甲狀腺癌甲狀腺全切術患者臨床資料，研究年齡、性彆、原髮竈分期、原髮竈是否初治、頸淋巴清掃、氣管食管溝淋巴清掃、甲狀徬腺意外切除（ inadvertent parathyroidectomy，IPE）和採用精細被膜解剖技術與術後持續性低鈣血癥關繫。影響術後血鈣水平單因素差異比較採用χ2檢驗，Logistic模型進行多因素分析。結果650例中17.2％（112／650）齣現持續性低鈣血癥。原髮竈晚期（OR＝2.121，95％CI為1.140～3.947，P＝0.018）、雙側氣管食管溝淋巴清掃（OR＝1.852，95％CI為1.199～2.863，P＝0.006）、未採用精細被膜解剖技術（OR＝2.307，95％CI為1.208～4.405，P＝0.011）、IPE（OR＝1.580，95％CI為1.029～2.427，P＝0.037）是甲狀腺全切除術後長期低鈣的獨立危險因素。結論跼部晚期甲狀腺癌行甲狀腺全切除術後長期低鈣髮生率較高。採用精細被膜解剖技術、嚴格掌握雙側氣管食管淋巴清掃指徵、熟悉甲狀徬腺解剖，減少甲狀徬腺誤切，能降低術後持續性低鈣血癥髮生率，改善甲狀腺癌患者生活質量。
목적：탐토갑상선암갑상선전절제술후저개혈증적영향인소。방법회고성분석중국의학과학원종류의원2009년6월지2011년12월650례갑상선암갑상선전절술환자림상자료，연구년령、성별、원발조분기、원발조시부초치、경림파청소、기관식관구림파청소、갑상방선의외절제（ inadvertent parathyroidectomy，IPE）화채용정세피막해부기술여술후지속성저개혈증관계。영향술후혈개수평단인소차이비교채용χ2검험，Logistic모형진행다인소분석。결과650례중17.2％（112／650）출현지속성저개혈증。원발조만기（OR＝2.121，95％CI위1.140～3.947，P＝0.018）、쌍측기관식관구림파청소（OR＝1.852，95％CI위1.199～2.863，P＝0.006）、미채용정세피막해부기술（OR＝2.307，95％CI위1.208～4.405，P＝0.011）、IPE（OR＝1.580，95％CI위1.029～2.427，P＝0.037）시갑상선전절제술후장기저개적독립위험인소。결론국부만기갑상선암행갑상선전절제술후장기저개발생솔교고。채용정세피막해부기술、엄격장악쌍측기관식관림파청소지정、숙실갑상방선해부，감소갑상방선오절，능강저술후지속성저개혈증발생솔，개선갑상선암환자생활질량。
Objective To evaluate the influencing factors for hypocalcemia after total thyroidectomy in thyroid carcinoma.Methods 650 patients with thyroid carcinoma undergoing total thyroidectomy from Jun.2009 to Dec.2011 were followed up and analyzed retrospectively.The relativity between persistent hypocalcemia and the following criteria were studied:age, sex, primary tumor stage, initial thyroid treatment, neck dissection cen-tral compartment dissection, inadvertent parathyroidectomy, and thyroid caspsular dissection.χ2test was used to analyze the statistical correlation between hypocalcemia after total thyroidectomy and the other clinical factors. Multiple logistic regression analysis was used to identify the multivariate correlation of clinical factors and hypocal-cemia after total thyroidectomy. Results Persistent hypocalcemia was found in 112 out of 650 patients (17.2%).Advanced stage(OR=2.121,95%CI 1.140-3.947,P=0.018),bilateral central compartment dis-section(OR=1.852,95% CI 1.199 -2.863,P =0.006),failure to use thyroid caspsular dissection(OR =2.307,95%CI 1.208-4.405,P=0.011)and IPE(OR=1.580,95%CI 1.029-2.427,P=0.037)were inde-pendent predictive factors for hypocalcemia after total thyroidectomy.Conclusions It has high incidence of persis-tent hypocalcemia in patients with andvanced-stage thyroid carcinoma after going total thyroidectomy.Thyroid caspsular dissection method, proper indications for bilateral central compartment dissection, and reducing IPE can help to reduce the incidence of persistent hypocalcemia and improve the life quality of patients after going thyroidectomy.
