切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 522 -525. doi: 10.3877/cma.j.issn.1674-3946.2020.05.025

所属专题: 文献

论著

不同钙剂和维生素D3补充方案对甲状腺癌双侧甲状腺切除术后并发症及预后情况的影响
袁建明1, 刘涛1,(), 靳晓丽1, 汪矛斐1, 王明亮2   
  1. 1. 200020 上海,上海交通大学医学院附属瑞金医院卢湾分院普外科
    2. 200020 上海,上海交通大学医学院附属瑞金医院普外科
  • 收稿日期:2020-03-10 出版日期:2020-10-26
  • 通信作者: 刘涛

Effects of different calcium and vitamin D3 supplementation schemes on the complications and prognosis of patients with thyroid cancer after bilateral thyroidectomy during perioperative period

Jianming Yuan1, Tao Liu1,(), Xiaoli Jin1, Maofei Wang1, Mingliang Wang2   

  1. 1. General surgery, Luwan branch, Ruijin Hospital, School of medicine, Shanghai Jiaotong University, Shanghai 200020, China
    2. General surgery, Ruijin Hospital, School of medicine, Shanghai Jiaotong University, Shanghai 200020, China
  • Received:2020-03-10 Published:2020-10-26
  • Corresponding author: Tao Liu
  • About author:
    Corresponding author: Liu Tao, Email:
  • Supported by:
    Project of Shanghai Huangpu district health committee(HKQ201901)
引用本文:

袁建明, 刘涛, 靳晓丽, 汪矛斐, 王明亮. 不同钙剂和维生素D3补充方案对甲状腺癌双侧甲状腺切除术后并发症及预后情况的影响[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(05): 522-525.

Jianming Yuan, Tao Liu, Xiaoli Jin, Maofei Wang, Mingliang Wang. Effects of different calcium and vitamin D3 supplementation schemes on the complications and prognosis of patients with thyroid cancer after bilateral thyroidectomy during perioperative period[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 522-525.

目的

探讨围术期内采用不同钙剂和维生素D3(VD3)应用于甲状腺癌双侧甲状腺切除术后并发症及预后的影响。

方法

回顾性分析2014年1月至2015年1月期间接受双侧甲状腺切除术后186例患者资料,按照不同钙剂和VD3补充方案分组,分为术前组(术前1周给予,68例)、术后组(术后给予,60例)和对照组(未给予,58例);选择SPSS22.0和GraphPad Prism软件进行分析和作图,血清Ca2+及PTH水平等计量资料以(±s)表示,采用单因素方差分析;术后并发症等计数资料采用χ2检验;预后生存情况绘制kaplan-meier生存曲线,P<0.05差异有统计学意义。

结果

术前组、术后组、对照组低血钙发生分别为1例(1.5%)、5例(8.53)、10例(17.2%);静脉补钙分别为1例(1.5%)、2例(3.3%)、7例(12.1%);高钙血症分别为0例、1例(1.7%)、4例(6.9%),三组在低血钙、静脉补钙、高钙血症方面比较,差异均有统计学意义(P<0.05)。三组患者术后5年复发率39.8%、5年生存率为86.6%,三组在生存预后方面对比,差异无统计学意义(P>0.05)。

结论

术前和术后应用钙剂和VD3均能降低甲状腺癌双侧甲状腺切除术后低钙血症的发生率,而术前应用钙剂和VD3更具有优势,但对于甲状腺癌患者的预后作用无影响。

Objective

To explore the effects of different calcium and vitamin D3 supplementation on complication and prognosis after bilateral thyroidectomy of thyroid cancer during the perioperative period.

Methods

The data of 186 patients with thyroid cancer who underwent bilateral thyroidectomy from January 2014 to January 2015 were retrospectively analyzed. They were divided into preoperative groups (68 Cases), postoperative group (60 cases) and control group (58 cases) according to different calcium and vitamin D3 supplementation, the preoperative group was given calcium and vitamin D3 1 week before the operation, the postoperative group was given calcium and vitamin D3 after the operation, and the control group was not given calcium and vitamin D3 .The SPSS22.0 and GraphPad Prism software were selected for statistical analysis and mapping. Measurement data such as serum Ca2+ and PTH levels were expressed as (±s), and compared by one-way analysis of variance; postoperative complications and other count data were compared by χ2; Kaplan-Meier survival curve was drewfor the prognostic survival. The difference was statistically significant when (P<0.05).

Results

The incidence of hypocalcemia in the preoperative group, postoperative group, and control group were 1 case (1.5%), 5 cases (8.53), and 10 cases (17.2%); intravenous calcium supplementation were 1 case (1.5%) and 2 cases(3.3%), 7 cases (12.1%); hypercalcemia were 0 cases, 1 case (1.7%), 4 cases (6.9%), The differences were statistically significant in hypocalcemia, intravenous calcium supplementation and hypercalcemia among the three groups (P<0.05). The 5-year recurrence rate of the three groups was 39.8% and the 5-year survival rate was 86.6%. There was no significant difference in survival prognosis among the three groups (P>0.05).

Conclusion

Preoperative and postoperative calcium and vitamin D3 supplementations can reduce the incidence of hypocalcemia after bilateral thyroidectomy of thyroid cancer, the former is more effective. But these supplementations have no effect on the prognosis of patients with thyroid cancer.

表1 186例甲状腺癌患者不同钙剂和VD3补充方案三组患者基线资料对比[(±s),例]
表2 186例甲状腺癌患者不同钙剂和VD3补充方案三组患者并发症发生情况[例(%)]
表3 186例甲状腺癌患者不同钙剂和VD3补充方案三组患者血清Ca2+及PTH水平比较(±s)
图1 186例甲状腺癌患者不同钙剂和VD3补充方案三组患者术后复发情况比较
图2 186例甲状腺癌患者不同钙剂和VD3补充方案三组患者术后生存率比较
[1]
Ryu YJ,Kang SJ,Cho JS,et al. Identifying risk factors of lateral lymph node recurrence in clinically node-negative papillary thyroid cancer[J]. Medicine(Baltimore), 2018,97(51):e13435.
[2]
王朝晖,伏桂明,陈锦,等.计算机辅助设计三维可视化技术在侵犯气管的甲状腺癌手术中的应用[J].中华耳鼻咽喉头颈外科杂志,2017, 52(10):774-776.
[3]
Coerper S, Dehnel J, Stengl W.Symptomatic hypocalcemia after thyroidectomy : Prevention by a combination of prophylaxis and risk-adapted substitution[J]. Chirurg,2018,89(11):909-916.
[4]
陈高翔,张海,吴伟主,等.弹性牵张式胸乳入路腔镜甲状腺癌手术40例[J].中华内分泌外科杂志,2018, 12(2):169-171.
[5]
吉倩婧,底瑞青,陈伟娜,等.机器人用于分化型甲状腺癌术后131I治疗住院患者体内残留放射性活度测定的研究[J].中华核医学与分子影像杂志,2019, 39(10):601-605.
[6]
Dedivitis RA,Aires FT,Cernea CR.Hypoparathyroidism after thyroidectomy: Prevention, assessment and management[J].Curr Opin Otolaryngol Head Neck Surg, 2017, 25(2):142-146.
[7]
常伟,韩星敏,刘保平,等.老年甲状腺癌患者手术临床疗效和预后分析[J].中华老年医学杂志,2018, 37(10):1115-1117.
[8]
Karatzanis AD,Ierodiakonou DP,Fountakis ES,et al.Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy[J]. Head Neck, 2018, 40(5):1040-1045.
[9]
Castro A,del Rio L,Gavilan J. Stratifying the risk of developing clinical hypocalcemia after thyroidectomy with parathyroid hormone[J]. Otolaryngol Head Neck Surg, 2017, 158(1):76-82.
[10]
Fortuny JV,Sadowski SM,Belfontali V,et al. Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery[J]. Br J Surg,2018,105(4):350-357.
[11]
Erlem M,Klopp-Dutote N,Biet-Hornstein A,et al.Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients[J]. J Laryngol Otol, 2017, 131(10):925-929.
[12]
Sanabria A,Rojas A, Arevalo J. Meta analysis of routine calcium/vitamin D3 supplementation versus serum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy[J]. Br J Surg, 2019, 106(9):1126-1137.
[13]
Riis MG, Juhl KS,Bruun JM. Concomitant sarcoidosis and papillary thyroid cancer with severe hypercalcaemia as the main symptom[J]. BMJ Case Rep, 2018, 2018:bcr2017222194.
[14]
Jaan S,Sehgal A,Wani RA,et al. Usefulness of pre-and post-operative calcium and Vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy: A randomized controlled trial[J]. Indian J Endocrinol Metab, 2017, 21(1):51-55.
[15]
Issing PR, Tebben H,Wenger M,et al. Prospective evaluation of the quality of the results of thyroid surgery in an ENT-department[J].Laryngorhinootologie, 2017, 96(4):230-233.
[16]
张立阳,刘春浩,曹越,等.125例复发/持续性分化型甲状腺癌再次手术及其预后影响因素分析[J].中国癌症杂志,2019, 29(6):412-417.
[17]
Epstein S,McEachern R,Khot R,et al.Papillary thyroid carcinoma recurrence: Low yield of neck ultrasound with an undetectable serum thyroglobulin level[J].J Ultrasound Med,2018,37(10):2325-2331.
[18]
Giannoula E,Iakovou I,Verburg FA. Long term quality of life in differentiated thyroid cancer patients after thyroidectomy and high doses of 131I with or without suppressive treatment[J]. Hell J Nucl Med, 2018, 21(1):69-73.
[19]
Zeng H, Chen W, Zheng R,et al.Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries[J].Lancet Glob Health, 2018, 6(5):e555-e567.
[20]
Oluic B,Paunovic I,Loncar Z,et al.Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: A single center experience[J]. BMC Cancer, 2017, 17(1):371.
[21]
Masudo K,Suganuma N, Nakayama H,et al. EZH2 overexpression as a useful prognostic marker for aggressive behaviour in thyroid cancer[J]. In Vivo, 2018, 32(1):25-31.
[1] 宋玟焱, 杜美君, 陈佳丽, 石冰, 黄汉尧. 唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 397-405.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[4] 王伟伟, 费建平, 王璋瑜. 不同手术空间建立方法的经口腔前庭入路腔镜甲状腺术对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 84-87.
[5] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[6] 孙莲, 马红萍, 吴文英. 局部进展期甲状腺癌患者外科处理[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 112-114.
[7] 麻紫月, 王贞文, 张强, 赵代伟, 张翊伦. 右侧喉不返神经1例报告[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 115-116.
[8] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[9] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[10] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[11] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[12] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[13] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[14] 韩俊岭, 王刚, 马厉英, 连颖, 徐慧. 维生素D 联合匹维溴铵治疗腹泻型肠易激综合征患者疗效及对肠道屏障功能指标的影响研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 560-564.
[15] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
阅读次数
全文


摘要