| 孙惠芳,郭海巍,金艾香.甲状腺二次手术后并发症的发生率以及甲状旁腺功能减退的危险因素分析[J].浙江中西医结合杂志,2022,32(1): |
| 甲状腺二次手术后并发症的发生率以及甲状旁腺功能减退的危险因素分析 |
| The incidence of complications after secondary thyroidectomy and the influencing factors of hypoparathyroidism |
| 投稿时间：2021-07-12 修订日期：2021-11-16 |
| DOI： |
| 中文关键词: 甲状腺 二次手术 甲状旁腺功能减退 危险因素 |
| 英文关键词:Thyroid Reoperation Hypoparathyroidism Risk factors |
| 基金项目:浙江省医药卫生科技项目(2020377230) |
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| 中文摘要: |
| 目的：探讨甲状腺二次手术后并发症的发生率以及甲状旁腺功能减退的危险因素。方法：回顾性分析 2016年1月至2019年1月浙江省人民医院头颈外科收治的93例甲状腺二次手术患者的临床资料，以是否出现永久性甲状旁腺功能减退将患者分为两组。先进行单因素分析，再将有统计学意义的危险因素进行多因素 logistic回归分析，筛选独立危险因素，并绘制受试者工作特征曲线ROC曲线，评价其检验效能。结果：93例甲状腺二次手术患者中，有2例患者出现术后血肿（2.15%），有7例术后出现喉返神经损伤（7.53%），有15例出现永久性甲状旁腺功能减退（16.13%）。单因素方差分析显示发生永久性甲状旁腺功能减退组患者二次手术间隔时间＜3个月、行颈中央区淋巴结清扫和合并桥本甲状腺炎的比例更高。多因素 Logistic回归分析显示二次手术时间间隔＜3个月（OR=6.206，P=0.009, 95%CI :1.567-24.575）和合并桥本甲状腺炎（OR=4.513，P=0.025, 95%CI :1.208-16.852）是影响甲状腺二次手术后甲状旁腺功能减退的独立危险因素（均 P＜0.05）。联合预测概率的曲线下面积（AUC）为 0.844，95%CI：0.731-0.956，预测敏感度为 93.3%，特异度为 67.9%，提示该 Logistic 回归模型预测效果较好。结论：二次手术时间间隔＜3个月和合并桥本甲状腺炎的甲状腺二次手术患者术后出现甲状旁腺功能减退的风险较大，应尽早给予甲状旁腺功能减退的预防性治疗。 |
| 英文摘要: |
| Objective: To investigate the incidence of complications after secondary thyroid surgery and the risk factors of hypoparathyroidism. Methods: A retrospective analysis of the clinical data of 93 patients with secondary thyroid surgery admitted to the Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital from January 2016 to January 2019, and divided the patients into two groups based on whether there was permanent hypoparathyroidism . Univariate analysis was performed, and multivariate logistic regression analysis was performed on the influential factors with statistical significance to screen independent risk factors.?Receiver operating characteristic curve (ROC) curve was drawn to evaluate the efficacy of the test. Results: Among 93 patients with secondary thyroid surgery, 2 patients had postoperative hematoma (2.15%), 7 patients had postoperative recurrent laryngeal nerve injury (7.53%), and 15 patients had permanent parathyroid function decline (16.13%). Univariate analysis showed that patients with permanent hypoparathyroidism had a higher rate of secondary surgery time less than 3 months, central cervical lymph node dissection, and combined Hashimoto's thyroiditis.Multivariate Logistic regression analysis showed that the second operation interval < 3 months (OR=6.206, P=0.009, 95%CI:1.567-24.575) and combined Hashimoto's thyroiditis (OR=4.513,P=0.025, 95%CI :1.208-16.852) was an independent risk factor for hypoparathyroidism after secondary thyroid surgery ( P < 0.05).The area under the curve (AUC) of the joint prediction probability was 0.844, 95%CI: 0.731-0.956, the prediction sensitivity was 93.3%, and the specificity was 67.9%, suggesting that the Logistic regression model had a good prediction effect. Conclusion: The time interval between secondary operations <3 months and Hashimoto's thyroiditis are associated with a higher risk of hypoparathyroidism after secondary thyroid surgery. Prophylactic treatment of hypoparathyroidism should be given as soon as possible. |
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