中文摘要 目的：本研究旨在探究甲状腺癌患者在接受甲状腺全切术后住院时间延长的 影响因素，以期为临床提供针对性的干预措施，改善患者术后恢复，缩短住院时 间。 方法：本研究回顾性分析了北京协和医院基本外科收治的甲状腺癌患者共 1135 例，其中符合本研究选入标准的甲状腺癌全切术的患者506 例。收集患者 术前（基本情况、甲状腺化验、甲状腺超声），术中（移植甲状旁腺、颈部侧方 淋巴结清扫），术后（甲状腺病理、引流、并发症）的数据，通过单因素分析和 多因素分析，以75%分位数的术后住院时间为切入点，筛选出与术后住院时间显 著相关的因素，并进一步将这些因素行Logistic多因素分析，通过绘制ROC曲 线建立预测模型，深入探讨影响甲状腺癌全切术后住院时间的因素。 结果：本文术后住院时间的75%分位数是4天，定义术后住院时间≥4天为 PPH 组，在506 名行甲状腺全切术的患者中，正常康复组376人，PPH组130 人。单因素分析中显示，性别、可疑淋巴结、结节形态、侧方清扫、中央淋巴结 阳性率、第一天引流量、总引流量、低钙麻木、声音嘶哑、淋巴瘘、饮水呛咳与 术后住院时间显著相关。Logistic回归分析进一步确认，男性发生PPH的概率是 女性的2.083倍（95%CI：1.287-3.372）， 若比较天数，男性PPH比女性延长1.0 （1.0,2.0）天；结节形态不规则患者发生 PPH 的概率是形态规则患者的 1.8 倍 （95%CI：1.122-3.085），前者 PPH 比后者的延长了1.0（1.0,1.0）天；侧方清扫 患者PPH概率是未进行侧方清扫的患者的1.2倍（95%CI：1.177-4.222），前者 的PPH比后者延长了1.0（1.0,1.0）天；出现并发症的患者PPH概率是无术后并 发症的9.038倍(95%CI,4.543-17.979)，前者的 PPH 比后者延长了2.0（1.0，2.0） 天；第一天引流量≥72.5ml，总引流量≥100.5ml时和PPH相关。 结论：性别、结节形态、侧方清扫、第一天引流量、总引流量、术后并发症 是甲状腺癌患者行甲状腺全切术后住院时间延长的主要影响因素。针对这些因素 进行有效的术前评估、合理的术前宣教，术中和术后管理，有助于缩短患者的住 院时间，提高医疗资源利用率，减轻患者的住院资金压力及心理压力。 关键词：甲状腺癌；甲状腺全切术；术后住院时间；侧方清扫；并发症

Abstract Objective: This study aims to explore the factors influencing Postoperative Hopitalization after total thyroidectomy in thyroid cancer patients, in order to provide targeted interventions in clinical practice, improve postoperative recovery, and shorten hospitalization time. Methods: This study retrospectively analyzed 1,135 thyroid cancer patients from Peking Union Medical College Hospital's General Surgery Department, focusing on 506 who underwent total thyroidectomy. Data collected covered preoperative (basic information, thyroid function tests, ultrasound), intraoperative (parathyroid transplantation, lateral neck dissection), and postoperative (pathology, drainage, complications) details. Using univariate and multivariate analyses, with the 75th percentile of postoperative hospitalization time as the threshold, the study aimed to identify factors significantly associated with postoperative hospitalization time and further assess their impact through Logistic regression and ROC curve analysis. Results: In this study, the 75th percentile of postoperative hospitalization time was 4 days, defining PPH as postoperative hospitalization ≥ 4 days. Of the 506 patients who underwent total thyroidectomy, 376 were in the normal recovery group and 130 in the PPH group. Univariate analysis showed that gender, suspicious lymph nodes, nodule morphology, lateral neck dissection, central lymph node positivity rate, first day drainage volume, total drainage volume, hypocalcemia with numbness, hoarseness, lymphatic fistula, and dysphagia were significantly associated with postoperative hospitalization time. Logistic regression analysis further confirmed that males had a 2.083 times higher risk of PPH than females (95%CI: 1.287-3.372), with an average extended hospital stay of 1.0 (1.0, 2.0) days. Patients with irregular nodule morphology had a 1.8 times higher risk of PPH than those with regular morphology (95%CI: 1.122 3.085), resulting in an additional 1.0 (1.0, 1.0) days of hospitalization. Lateral neck dissection was associated with a 1.2 times increased risk of PPH (95%CI: 1.177-4.222), leading to an extra 1.0 (1.0, 1.0) days of hospitalization. Patients with postoperative complications had a 9.038 times higher risk of PPH (95%CI: 4.543-17.979), prolonging hospitalization by 2.0 (1.0, 2.0) days. Additionally, a first-day drainage volume ≥ 72.5 ml and a total drainage volume ≥ 100.5 ml were significantly associated with PPH. Conclusion: Gender, nodule morphology, lateral neck dissection, first-day drainage volume, total drainage volume, and postoperative complications are the main factors influencing PPH after total thyroidectomy in thyroid cancer patients. Effective preoperative assessment, reasonable preoperative education, and intraoperative and postoperative management