Warren Frank M, Andersen Peter E, Wax Mark K, Cohen James I
Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon 97201, USA.
Laryngoscope. 2002 Oct;112(10):1866-70. doi: 10.1097/00005537-200210000-00031.
To determine the utility of intraoperative parathyroid hormone measurement in predicting postoperative hypocalcemia after thyroid and parathyroid surgeries that places total parathyroid function at risk.
Retrospective case review.
The case records of 23 patients undergoing total or completion thyroidectomy and 30 patients undergoing parathyroid exploration were reviewed. All patients had intraoperative parathyroid hormone levels measured. Samples were taken before dissection and 10 minutes after the resection was completed. Serial ionized calcium levels were measured in the postoperative period. Percentages of reduction in PTH levels from preoperative to postresection levels were calculated. Percentages of reduction in PTH level and the absolute value of the intraoperative PTH values were compared with postoperative ionized calcium levels.
In the 23 patients who underwent thyroid surgery, the average preoperative and postoperative PTH values were 50 pg/mL (range, 17-87 pg/mL) and 34 pg/mL (range, 4-93 pg/mL), respectively. The average decrease in PTH was 39% (range, 39%-90%). The incidence of hypocalcemia was significantly higher in patients with intraoperative PTH levels less than 15 pg/mL relative to patients with PTH levels greater than 15 pg/mL in this setting ( P=.006). In the 30 patients who underwent parathyroid exploration, average preoperative and postoperative PTH levels were 291 pg/mL (range, 65-1675 pg/mL) and 113.8 pg/mL (range, 6.5-1263 pg/mL) respectively. The intraoperative PTH level did not correlate with postoperative calcium levels in the parathyroid group. Percentages of decrease in PTH levels greater than 60% was statistically associated with surgical cure in this population.
The study demonstrates that intraoperative PTH levels greater than 15 pg/mL after total or completion thyroidectomy indicate a low risk of postoperative hypocalcemia and that these patients may be candidates for outpatient surgery. In the parathyroid group, intraoperative PTH levels do not correlate well with postoperative calcium levels.
确定术中甲状旁腺激素测量在预测甲状腺和甲状旁腺手术中全甲状旁腺功能有风险时术后低钙血症的效用。
回顾性病例分析。
回顾了23例行全甲状腺切除术或甲状腺次全切除术患者以及30例行甲状旁腺探查术患者的病例记录。所有患者均测量了术中甲状旁腺激素水平。在解剖前及切除完成后10分钟采集样本。术后定期测量血清离子钙水平。计算甲状旁腺激素水平从术前到切除后水平的降低百分比。将甲状旁腺激素水平降低百分比及术中甲状旁腺激素值的绝对值与术后离子钙水平进行比较。
在23例行甲状腺手术的患者中，术前和术后甲状旁腺激素的平均水平分别为50 pg/mL（范围17 - 87 pg/mL）和34 pg/mL（范围4 - 93 pg/mL）。甲状旁腺激素平均降低39%（范围39% - 90%）。在此情况下，术中甲状旁腺激素水平低于15 pg/mL的患者低钙血症发生率显著高于甲状旁腺激素水平高于15 pg/mL的患者（P = 0.006）。在30例行甲状旁腺探查术的患者中，术前和术后甲状旁腺激素平均水平分别为291 pg/mL（范围65 - 1675 pg/mL）和113.8 pg/mL（范围6.5 - 1263 pg/mL）。甲状旁腺组中术中甲状旁腺激素水平与术后钙水平不相关。在该人群中，甲状旁腺激素水平降低大于60%与手术治愈在统计学上相关。
该研究表明，全甲状腺切除术或甲状腺次全切除术后术中甲状旁腺激素水平大于15 pg/mL表明术后低钙血症风险较低，这些患者可能适合门诊手术。在甲状旁腺组中，术中甲状旁腺激素水平与术后钙水平相关性不佳。
