甲状腺手术后发生低甲状旁腺激素及低血钙的影响因素分析

发布时间：2018-04-14 02:19

本文选题：甲状腺 + 手术　；参考：《河南大学》2015年硕士论文

【摘要】：目的:从接受甲状腺手术患者的临床资料入手,分析找出引发术后甲状旁腺功能减退、低血钙的影响因素,并进一步探讨如何减少术后发生甲状旁腺功能减退及低血钙的发生。方法:回顾性分析河南省肿瘤医院甲状腺颈部外科于2013年3月至2014年2月收治的行甲状腺手术的患者,共194例。收集患者的以下资料:性别、年龄、手术方式、术前甲状旁腺激素(PTH)、术前血钙、术后PTH、术后血钙、病种(病理诊断)、术后有无低血钙的自觉症状。分组后使用SPSS17.0软件进行统计学分析。结果:194例患者中术后发生PTH水平较手术前降低的患者共158例,其中有53例出现甲状旁腺功能减退;术后发生血钙水平较术前降低的患者共190例,其中有146例发生低血钙。术后出现低血钙的自觉症状的患者有38例。统计分析结果显示几乎所有接受甲状腺手术的患者在术后都有不同程度的PTH、血钙水平较术前的下降。手术方式对术后PTH、血钙的降低有影响,手术方式中,双叶切除较单叶切除,术后发生PTH、血钙水平较术前降低的概率大;年龄段、病种对术后PTH、血钙的降低没有影响;性别对术后PTH较术前降低似乎有些作用,但对术后血钙水平的降低无影响。手术方式对术后甲状旁腺功能减退、低钙血症的发生有影响,手术方式中,双叶切除较单叶切除,术后甲状旁腺功能减退、低钙血症发生的概率大,年龄段、性别、病种对术后甲状旁腺功能减退、低钙血症的发生没有影响。术后PTH、血钙水平的下降具有普遍性,无法预测术后一定发生低血钙的自觉症状,术后未发生低血钙自觉症状也不能认为一定没有发生PTH、血钙水平的降低。低血钙自觉症状的出现对PTH水平的降低有提醒作用,而无论有无低血钙自觉症状的出现,术后血钙水平的降低似乎是普遍的情况。低血钙自觉症状对术后甲状旁腺功能减退、低钙血症的发生有提醒作用。结论:1.甲状腺手术后PTH、血钙水平较术前的下降具有普遍性,血钙水平下降较PTH水平下降的概率更大;2.手术方式对术后PTH、血钙水平的下降和术后甲状旁腺功能减退、低钙血症的发生有影响,手术范围越大,术后PTH、血钙水平下降和术后甲状旁腺功能减退、低钙血症的发生概率越大;淋巴结清扫范围无此影响;3.年龄段、病种对术后PTH、血钙的下降和术后甲状旁腺功能减退、低钙血症的发生没有影响,性别对术后PTH的降低似乎有些作用,但对术后血钙水平的降低无影响,同时对术后甲状旁腺功能减退、低钙血症的发生也没有影响。
[Abstract]:Objective: to find out the influencing factors of hypothyroidism and hypoparathyroidism from the clinical data of patients undergoing thyroid surgery, and to explore how to reduce the incidence of hypothyroidism and hypocalcemia.Methods: 194 cases of thyroid surgery in Henan Cancer Hospital from March 2013 to February 2014 were retrospectively analyzed.The following data were collected: sex, age, operation mode, PTH, preoperative serum calcium, postoperative PTH, postoperative calcium, disease (pathological diagnosis, postoperative hypocalcemia or not).After grouping, SPSS17.0 software was used for statistical analysis.Results there were 158 cases with decreased PTH level after operation, 53 cases with hypoparathyroidism, and 190 cases with decreased serum calcium level after operation, including 146 cases with hypocalcemia.There were 38 patients with hypocalcemia after operation.Statistical analysis showed that almost all patients undergoing thyroid surgery had different levels of PTH, and the serum calcium level was lower than that before operation.The operation mode had an effect on the decrease of PTH and serum calcium. In the operation mode, the rate of PTH was higher after double lobectomy than that of single lobectomy, and the level of serum calcium was lower than that before operation, age, disease type had no effect on the decrease of PTH and serum calcium after operation.Sex seemed to have some effect on the decrease of PTH after operation, but had no effect on the decrease of serum calcium level after operation.The operation mode has influence on the occurrence of hypothyroidism and hypocalcemia after operation. In the operation mode, bilateral lobectomy is more than single lobectomy, postoperative hypoparathyroidism, hypocalcemia is more likely, age, sex,The incidence of hypoparathyroidism and hypocalcemia was not affected by the disease.The decrease of PTH and serum calcium level is universal, it is impossible to predict the spontaneous symptoms of hypocalcemia after operation, nor can it be considered that there is no PTH and the decrease of serum calcium level.The appearance of hypocalcemia may be a reminder of the decrease of PTH level, and whether or not hypocalcemia occurs, the decrease of serum calcium level seems to be common after operation.Hypocalcemia is a reminder of hypoparathyroidism and hypocalcemia.Conclusion 1.The decrease of serum calcium level after thyroid surgery was more common than that before operation, and the probability of the decrease of serum calcium level was higher than that of PTH level.The postoperative PTH, the decrease of serum calcium level and the decrease of parathyroid function and hypocalcemia after operation were affected by the operative method. The larger the scope of operation, the lower the serum calcium level, the lower the function of parathyroid gland after operation.The higher the probability of hypocalcemia, the greater the extent of lymph node dissection.Age group had no effect on PTH, serum calcium, hypothyroidism and hypocalcemia. Sex seemed to have some effect on the decrease of postoperative PTH, but had no effect on the decrease of serum calcium level.At the same time, the incidence of hypocalcemia and parathyroid hypothyroidism was not affected.
【学位授予单位】：河南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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