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全甲状腺切除术后短暂性甲状旁腺功能减退的危险因素:队列分析的见解

Risk Factors for Transient Hypoparathyroidism after Total Thyroidectomy: Insights from a Cohort Analysis.

作者信息

Graceffa Giuseppa, Lopes Antonella, Orlando Giuseppina, Mazzola Sergio, Vassallo Fabrizio, Curione Francesco, Richiusa Pierina, Radellini Stefano, Melfa Giuseppina, Scerrino Gregorio

机构信息

Unit of General and Oncology Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico "P. Giaccone", University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy.

Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico "P. Giaccone", University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy.

出版信息

J Clin Med. 2024 Jun 5;13(11):3326. doi: 10.3390/jcm13113326.

Abstract

Transient hypoparathyroidism (TH) is the main post-thyroidectomy complication, significantly impacting surgical outcomes, hospitalization length, and perceived perceived quality of life understood as mental and physical well-being. This study aims to identify possible associated risk factors. We analyzed 238 thyroidectomies (2020-2022), excluding instances of partial surgery, primary hyperparathyroidism, neck irradiation history, and renal failure. The variables considered were as follows: demographics, histology, autoimmunity, thyroid function, pre- and postoperative Vitamin D levels (where available), type of surgery, number of incidentally removed parathyroid glands (IRP), and surgeons' experience (>1000 thyroidectomies, <500, in training). Univariate analysis applied: χ, Fisher's exact test for categorical variables, and Student's -test for continuous variables. Subsequently, logistic multivariate analysis with stepwise selection was performed. Univariate analysis did not yield statistically significant results for the considered variables. The 'No Complications' group displayed a mean age of 55 years, whereas the TH group showed a mean age of 51 (-value = 0.055). We considered this result to be marginally significant. Subsequently, we constructed a multivariate logistic model. This model (AIC = 245.02) indicated that the absence of incidental parathyroidectomy was associated with the age class >55 years, presenting an odds ratio (OR) of 9.015 (-value < 0.05). Simultaneously, the age class >55 years exhibited protective effects against TH, demonstrating an OR of 0.085 (-value < 0.01). Similarly, the absence of incidental parathyroidectomy was found to be protective against TH, with an OR of 0.208 (-value < 0.01). Multivariate analysis highlighted that having "No IRP" was protective against TH, while younger age was a risk factor. Surgeon experience does not seem to correlate with IRP or outcomes, assuming there is adequate tutoring and a case volume close to 500 to ensure good results. The effect of reimplantation has not been evident in transient hypoparathyroidism.

摘要

短暂性甲状旁腺功能减退(TH)是甲状腺切除术后的主要并发症,对手术结果、住院时间以及被视为身心健康的生活质量有显著影响。本研究旨在确定可能的相关危险因素。我们分析了238例甲状腺切除术(2020 - 2022年),排除了部分手术、原发性甲状旁腺功能亢进、颈部放疗史和肾衰竭的病例。所考虑的变量如下:人口统计学特征、组织学、自身免疫性、甲状腺功能、术前和术后维生素D水平(如可获取)、手术类型、意外切除甲状旁腺的数量(IRP)以及外科医生的经验(甲状腺切除术超过1000例、少于500例、正在培训)。应用单因素分析:对于分类变量采用χ²检验、Fisher精确检验,对于连续变量采用Student's t检验。随后,进行逐步选择的逻辑多因素分析。单因素分析对所考虑的变量未得出具有统计学意义的结果。“无并发症”组的平均年龄为55岁,而TH组的平均年龄为51岁(P值 = 0.055)。我们认为这一结果具有边缘显著性。随后,我们构建了一个多因素逻辑模型。该模型(AIC = 245.02)表明,未进行意外甲状旁腺切除术与年龄大于55岁相关,呈现出9.015的比值比(OR)(P值 < 0.05)。同时,年龄大于55岁对TH具有保护作用,OR为0.085(P值 < 0.01)。同样,未进行意外甲状旁腺切除术被发现对TH具有保护作用,OR为0.208(P值 < 0.01)。多因素分析强调,“无IRP”对TH具有保护作用,而年龄较小是一个危险因素。假设存在充分的指导且病例数量接近500以确保良好结果,外科医生的经验似乎与IRP或结果无关。在短暂性甲状旁腺功能减退中,甲状旁腺再植的效果尚不明显。

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