文章：

在一项涉及1965名患者的研究中，甲状腺全切除术后及持续性甲状旁腺功能减退的风险与保护因素分析

Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients

原文发布日期：17 August 2024

DOI: 10.3390/cancers16162867

类型: Article

开放获取: 是

英文摘要：

Background: Postoperative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. Several risk factors have been identified, but data on postoperative follow-up are scarce. Methods: The study focused on 1965 patients undergoing surgery for benign and malignant thyroid diseases at a tertiary-level academic center. Anamnestic, biochemical, surgical, pathological, and follow-up data were evaluated. HypoPTH was defined by a serum concentration of PTH < 10 pg/mL on the first or the second post-operative day. Persistent HypoPTH was defined by the need for calcium/active vitamin D treatment > 12 months after surgery. Results: Postoperative HypoPTH occurred in 542 patients. Multivariate analysis identified the association of central lymph-nodal dissection, reduced preoperative PTH levels, a lower rate of parathyroid glands preserved in situ, and longer duration of surgery as independent risk factors. At a median follow-up of 47 months, HypoPTH regressed in 443 patients (more than 6 months after surgery in 7%) and persisted in 53 patients. Patients receiving a lower dose of calcium/active vitamin D treatment at discharge (HR 0.559;p< 0.001) or undergoing prolonged, tailored, and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent HypoPTH (2.4% compared to 32.8% for other specialists) (HR 2.563;p< 0.001). Conclusions: Various patient, disease, and surgeon-related risk factors may predict postoperative HypoPTH. Lower postoperative calcium/active vitamin D treatment and prolonged, tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH.

摘要翻译： 

背景：术后甲状旁腺功能减退症是全甲状腺切除术后最常见的并发症。目前已识别出多种风险因素，但关于术后随访的数据较为匮乏。方法：本研究纳入某三级学术中心1965例因良恶性甲状腺疾病接受手术的患者，对其病史、生化指标、手术记录、病理资料及随访数据进行评估。术后甲状旁腺功能减退定义为术后第一或第二天血清甲状旁腺激素浓度低于10 pg/mL，持续性甲状旁腺功能减退定义为术后12个月以上仍需钙剂/活性维生素D治疗。结果：542例患者发生术后甲状旁腺功能减退。多变量分析显示，中央区淋巴结清扫、术前甲状旁腺激素水平降低、原位保留甲状旁腺数量较少及手术时间延长是独立风险因素。中位随访47个月后，443例患者甲状旁腺功能恢复正常（其中7%在术后6个月以上恢复），53例患者发展为持续性甲状旁腺功能减退。出院时接受较低剂量钙剂/活性维生素D治疗（风险比0.559；p<0.001），或由手术内分泌外科团队进行长期个体化直接随访的患者（发生率2.4%，其他专科医生随访组为32.8%），其持续性甲状旁腺功能减退风险显著降低（风险比2.563；p<0.001）。结论：患者个体因素、疾病特征及手术相关风险因素均可预测术后甲状旁腺功能减退的发生。术后采用较低剂量钙剂/活性维生素D治疗方案，并由手术内分泌外科医生实施长期个体化直接随访，可显著降低持续性甲状旁腺功能减退的发生率。

原文链接：

Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients