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中华普外科手术学杂志(电子版)

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)
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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]. 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]. 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。

关键词: 甲状腺肿瘤, 甲状腺切除术, 维生素D, 预后, 疗效比较研究, 围手术期
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.

Key words: Thyroid neoplasms, Thyroidectomy, Vitamin D, Prognosis, Comparative effectiveness research, Perioperative period
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]
组别 例 性别 年龄(岁) 病程(月) 肿瘤类型
男/女 A/B/C/D
术前组 68 24/44 54.36±8.6 13.1±2.7 59/4/3/2
术后组 60 21/39 54.8±8.8 12.7±3.1 53/3/3/1
对照组 58 22/36 55.0±9.3 12.8±3.0 52/3/2/1
统计值 ? 0.234 0.098 0.634 0.252
P值 ? 0.935 0.906 0.578 0.881
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(%)]
组别 例 喉返神经损伤 甲状旁腺功能减退 低血钙 静脉补钙 高钙血症
术前组 68 3(4.4) 8(11.7) 1(1.5)ab 1(1.5)b 0(0)b
术后组 60 4(6.7) 12(20.0) 5(8.3)b 2(3.3)b 1(1.7)b
对照组 58 4(6.9) 13(22.4) 10(17.2) 7(12.1) 4(6.9)
χ2值 ? 0.437 1.738 9.910 7.637 6.004
P值 ? 0.804 0.419 0.007 0.022 0.048
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)
组别 例 ? Ca2＋(mmol/l) PTH(pg/ml)
术前组 68 术前1 d 2.2±0.4 45.1±8.6
? ? 术后1 d 1.9±0.4ab 24.7±4.3
? ? 术后5 d 2.2±0.4 37.6±5.7
? ? 术后3月 2.2±0.4 41.3±8.4
术后组 60 术前1 d 2.2±0.3 45.4±7.9
? ? 术后1 d 1.8±0.3b 26.4±5.2
? ? 术后5 d 2.1±0.3 38.4±6.3
? ? 术后3月 2.2±0.4 42.7±8.8
对照组 58 术前1 d 2.3±0.4 45.8±9.1
? ? 术后1 d 1.7±0.4 25.7±6.1
? ? 术后5 d 2.0±0.3 36.8±7.2
? ? 术后3月 2.1±0.4 44.3±8.7
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
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