天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (8): 826-830.doi: 10.11958/20250183

• 临床研究 • 上一篇    下一篇

胸乳入路腔镜甲状腺术后早期低钙血症的危险因素分析及预测模型构建

刘志远(), 杨声飞, 钱释然, 邓忆莲, 黎东伟, 李君久△()   

  1. 东莞东华医院普外科（邮编523110）
  • 收稿日期:2025-01-21 修回日期:2025-06-05 出版日期:2025-08-15 发布日期:2025-08-12
  • 通讯作者: △E-mail：13527965368@163.com
  • 作者简介:刘志远（1989），男，主治医师，主要从事甲状腺和胃肠疾病方面研究。E-mail：liuzhiyuan0216@163.com
  • 基金资助:
    广东省东莞市社会科技发展（重点）项目(202050715046226)

Analysis of risk factors and construction of a predictive model for early hypocalcemia after endoscopic thyroidectomy by breast approach

LIU Zhiyuan(), YANG Shengfei, QIAN Shiran, DENG Yilian, LI Dongwei, LI Junjiu△()   

  1. Department of General Surgery, Dongguan Tungwah Hospital, Dongguan 523110, China
  • Received:2025-01-21 Revised:2025-06-05 Published:2025-08-15 Online:2025-08-12
  • Contact: △E-mail：13527965368@163.com

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摘要：

目的 探讨经胸乳入路腔镜甲状腺手术（ETBA）后早期低钙血症的危险因素，并构建预测模型评估其发生风险。方法 选择实施ETBA的甲状腺结节患者155例，根据术后24 h血清钙水平分为低钙组（<2 mmol/L，41例）和正常组（≥2 mmol/L，114例）。术前检测甲状腺功能、甲状旁腺激素（PTH），并行超声评估颈部淋巴结肿大、结节位置、最大肿瘤直径、结节紧贴包膜、钙化、结节边缘情况；记录切除腺体（单侧或双侧）、手术时间、甲状旁腺误切等手术情况；术后24 h检测PTH及血清钙；病理学评估良恶性、桥本甲状腺炎、多灶性病变、甲状腺被膜侵犯及淋巴结转移情况。结果 与正常组相比，低钙组颈部淋巴结转移、恶性结节、多灶病变、颈部淋巴结肿大、切除双侧腺体、甲状旁腺误切、合并桥本甲状腺炎、最大肿瘤直径、手术时间均升高，术后24 h PTH降低（P<0.05）。多因素Logistic回归分析显示，颈部淋巴结转移、手术时间长、甲状旁腺误切、合并桥本甲状腺炎及最大肿瘤直径长为ETBA早期低钙血症的独立危险因素。据此构建可视化列线图模型，区分度优异[受试者工作特征（ROC）曲线下面积为0.920（95%CI：0.834~0.971）]，校准曲线显示预测值与实测值高度一致（Hosmer-Lemeshow χ2=0.007，P=0.087）。结论 基于多因素Logistic回归构建的列线图模型可有效预测ETBA术后早期低钙血症的发生风险。

关键词: 甲状腺结节, 甲状腺切除术, 低钙血症, 列线图

Abstract:

Objective To explore the risk factors of early hypocalcemia after endoscopic thyroidectomy by breast approach (ETBA) and establish a predictive model to evaluate its occurrence risk. Methods A total of 155 patients with thyroid nodules who underwent ETBA were selected. Patients were divided into the low calcium group (<2 mmol/L, n=41) and the normal group (≥2 mmol/L, n=114) according to the serum calcium level 24 hours after the operation. Before the operation, thyroid function and parathyroid hormone (PTH) were detected, and ultrasound was performed to evaluate cervical lymph node enlargement. Meanwhile, nodule location, maximum tumor diameter, nodule adhesion to the capsule, calcification and the edge of the nodule were also detected. The surgical conditions such as gland resection (unilateral or bilateral), operation time and misresection of parathyroid glands were recorded. PTH and serum calcium were detected 24 hours after the operation. Pathological assessment was used to evaluate benign and malignant conditions, Hashimoto's thyroiditis, multifocal lesions, thyroid capsule invasion and lymph node metastasis. Results Compared with the normal group, the cervical lymph node metastasis, malignant nodules, multifocal lesions, cervical lymph node enlargement, bilateral gland resection, parathyroid gland resection by mistake, combined Hashimoto's thyroiditis, maximum tumor diameter and operation time were increased in the hypocalcemia group, but PTH at 24 hours after the operation was decreased (P<0.05). Multivariate Logistic regression analysis showed that cervical lymph node metastasis, long operation time, parathyroid resection by mistake, combined Hashimoto's thyroiditis and maximum tumor diameter were independent risk factors for early hypocalcemia in ETBA. Based on this, a visual nomogram model was constructed, with excellent discrimination [the area under the receiver operating characteristic (ROC) curve was 0.920 (95%CI: 0.834-0.971)], and the calibration curve showed that the predicted values were highly consistent with the measured values (Hosmer-Lemeshow χ2=0.007, P=0.087). Conclusion The nomogram model constructed based on multivariate Logistic regression can effectively predict the risk of early hypocalcemia after ETBA.

Key words: thyroid nodule, thyroidectomy, hypocalcemia, nomogram

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