微创医学

目的探讨甲状腺切除术后患者发生甲状旁腺功能减退的影响因素，并构建预测模型。方法收集222例行甲状腺切除术治疗的乳头状甲状腺癌患者的临床资料，根据患者是否发生甲状旁腺功能减退，将其分为发生组（74例）和未发生组（148例），分析甲状腺切除术后患者发生甲状旁腺功能减退的影响因素，并构建预测模型。采用受试者操作特征（ROC）曲线评估预测模型的预测效能。结果甲状腺切除术后患者发生甲状旁腺功能减退的发生率为33.33%。与未发生组比较，发生组合并桥本甲状腺炎、肿瘤侵犯包膜、行双侧中央的淋巴结清扫、行侧颈区淋巴结清扫比例更高，行单侧中央区淋巴结清扫比例更低（P<0.05）。多因素 Logistic回归分析结果显示，甲状腺切除术患者术中行双侧中央区淋巴结清扫、侧颈区淋巴结清扫，术前合并桥本甲状腺炎，肿瘤侵犯包膜是术后发生甲状旁腺功能减退的危险因素（P<0.05）。基于上述危险因素构建的预测模型为Log（P）= 1.392+0.548×合并桥本甲状腺炎+0.664×肿瘤侵犯包膜+0.780×双侧中央区淋巴结清扫+0.677×侧颈区淋巴结清扫，该模型ROC曲线下面积为0.937（95%CI：0.908，0.966），灵敏度为88.61%、特异度为86.03%。结论甲状腺切除术中行双侧中央区淋巴结清扫及侧颈区淋巴结清扫，术前合并桥本甲状腺炎，肿瘤侵犯包膜是患者术后发生甲状旁腺功能减退的危险因素，且基于上述因素构建的预测模型能较好地预测患者发生甲状旁腺功能减退。

Objective To investigate the influencing factors of hypoparathyroidism in patients after thyroidectomy and establish a predictive model. Methods Clinical data of 222 patients with papillary thyroid carcinoma who underwent thyroidectomy were collected. According to the presence and absence of post-thyroidectomy hypoparathyroidism, they were divided into an occurrence group (74 cases) and a non-occurrence group (148 cases). The influencing factors of hypoparathyroidism in patients after thyroidectomy were analyzed, and a predictive model was established accordingly. The receiver operating characteristic (ROC) curve was adopted to evaluate the predictive efficacy of the established model. Results The incidence of hypoparathyroidism in patients after thyroidectomy was 33.33%. Compared with the non-occurrence group, the occurrence group had a higher proportion of patients complicated with chronic lymphocytic thyroiditis, tumor capsule invasion, bilateral central neck lymph node dissection and lateral neck lymph node dissection, and a lower proportion of patients with unilateral central neck lymph node dissection (P<0.05). Results of multivariate Logistic regression analysis showed that intraoperative bilateral central neck lymph node dissection and lateral neck lymph node dissection, tumor capsule invasion, and preoperatively complicated with chronic lymphocytic thyroiditis, were independent risk factors for post-thyroidectomy hypoparathyroidism in patients undergoing thyroidectomy (P<0.05). The predictive model established based on the aforementioned risk factors was expressed as Log(P) = 1.392+0.548× complicated with chronic lymphocytic thyroiditis +0.664× tumor capsule invasion +0.780× bilateral central neck lymph node dissection + 0.677× lateral neck lymph node dissection. For this model, the area under the ROC curve was 0.937 (95%CI: 0.908, 0.966), with a sensitivity of 88.61% and a specificity of 86.03%. Conclusion Bilateral central neck lymph node dissection and lateral neck lymph node dissection during throidectomy, preoperatively complicated with chronic lymphocytic thyroiditis, and tumor capsule invasion are independent risk factors for post-thyroidectomy hypoparathyroidism in patients undergoing thyroidectomy, and the predictive model established based on the aforementioned factors can effectively predict the occurrence of hypoparathyroidism in patients.

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