中国实用外科杂志

中国实用外科杂志

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影响继发性甲状旁腺功能亢进手术疗效相关因素分析

殷照才a，赵晚君a，盛    勇a，梅振宇a，王亚兵a，彭    辉b   

  1. 皖南医学院弋矶山医院  a.甲状腺和乳腺外科  b. 感染管理科/循证医学教研室,安徽芜湖241000
  • 出版日期:2018-06-01 发布日期:2018-06-21

  • Online:2018-06-01 Published:2018-06-21

摘要：

目的    探讨影响继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT）手术疗效的关键因素，为提高SHPT手术效果、减少术后并发症提供依据。方法    回顾性分析皖南医学院弋矶山医院收治的59例SHPT手术病人资料，按照术后6个月内复查血清全段甲状旁腺激素（ intact parathyroid hormone，iPTH）水平分为疗效较满意组（A组，iPTH＜150 ng/L）和疗效欠满意组（B组，iPTH ＞150 ng/L）。比较两组病人术前临床资料、术中探查甲状旁腺及切除甲状旁腺的数目、术前PTH（iPTH0）及术中全段甲状旁腺素（intraoperative serum intact parathyroid hormone, io-iPTH）等指标；采用Logistic回归模型筛选SHPT手术疗效相关因素。io-iPTH10均值=（io-iPTH10右侧+ io-iPTH10左侧）/2，io-iPTH20均值同理得之。结果    SHPT术后疗效较满意组（A组）49例，欠满意组（B组）10例。单因素分析显示术中额外探查甲状旁腺数目、io-iPTH10均值、io-iPTH20均值、io-iPTH10均值/ iPTH0、io-iPTH20均值/ iPTH0与手术疗效相关（ P值均< 0.05），其余指标与手术疗效无明显相关（ P值均＞0.05）。Logistic 回归分析显示术中额外探查甲状旁腺数目是SHPT手术疗效的保护因素（OR=0.109，95%CI 0.015~0.795）；io-iPTH 10均值为SHPT手术疗效的危险因素（OR=2.560，95%CI 1.444~4.541）。结论    术中额外探查甲状旁腺数目以及io-iPTH对手术探查的指导和手术终点的预判，是影响继发性甲状旁腺功能亢进手术疗效的关键因素。

关键词: 继发性甲状旁腺功能亢进, 甲状旁腺, 甲状旁腺切除术, 甲状旁腺激素

Abstract:

Correlation factor analysis of influencing the operative effect of secondary hyperparathyroidism        YIN Zhao-cai*, ZHAO Wan-jun, SHENG Yong, et al. *Department of Thyroid and Breast Surgery, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241000, China
Corresponding author: YIN Zhao-cai, E-mail：yinzc200@163.com
Abstract    Objective    To analyze the correlation factors of influencing the operative effect of secondary hyperparathyroidism（SHPT），and to provide evidence for the improvement of postoperative effect and the reduction of postoperative complications. Methods    The data of 59 cases of Yijishan Hospital Affiliated to Wannan Medical College of SHPT operation were reviewed retrospectively. According to the level of the serum intact parathyroid hormone（iPTH） within 6 months after operation，patients were divided into group A（iPTH＜150 ng/L） and group B （iPTH＞150 ng/L）. The factors were compared between two groups, including the preoperative clinical data, the number of parathyroid glands which were exposed during the operation, the number of parathyroid glands which were cut during the operation, preoperative serum intact parathyroid hormone（iPTH0）and intraoperative serum intact parathyroid hormone (io-iPTH) and others. Logistic regression model was used to select the correlation factors of influencing the surgical outcome of SHPT. Those data were recorded, such as iPTH0，10 and 20 min after removing the last parathyroid on the left side and right side （io-iPTH10L，io-iPTH20L，io-iPTH10R and io-iPTH20R），the mean of io-iPTH10L and io-iPTH10R （io-iPTH10M），and the mean of io-iPTH20L and io-iPTH20R （io-iPTH20M）. Results    The surgical outcome was more satisfactory in 49 cases （group A），but less satisfactory in 10 cases （group B）. Single factor analysis showed that io-iPTH10M，io-iPTH20M，io-iPTH10M/ iPTH0，io-iPTH20M/ iPTH0 and the number of parathyroid glands explosed additionally during the operation were significantly correlated with operative effect （P＜0.05）, while the others were not（P＞0.05）. Logistic regression analysis showed the number of parathyroid glands explored additionally during the operation was a protective factor influencing the operative effect（OR=0.109，95%CI：0.015-0.795），while io-iPTH10M was a risk factor influencing the operative effect（OR=2.560，95%CI：1.444-4.541）. Conclusion    The number of parathyroid glands explored additionally during the operation and io-iPTH which was used to be a guidance for surgical exploration and a prediction about the end of operation were the key factors influencing the operative effect of SHPT.

Key words: secondary hyperparathyroidism, parathyroid gland, parathyroidectomy, parathyroid hormone