Pisanu Adolfo, Cois Alessandro, Piu Sara, Altana Maria Luisa, Uccheddu Alessandro
Semeiotica Chirurgica, Dipartimento Chirurgico Materno-Infantile e di Scienze dell'Immagine Centro di Studio per la Chirurgia Endocrina e Metabolica, University of Cagliari.
Chir Ital. 2003 Jan-Feb;55(1):35-40.
Postoperative hypocalcaemia is often observed after total thyroidectomy. In patients requiring calcium replacement therapy after 1 year, hypocalcaemia must be considered permanent. The aim of this study was to assess the incidence of hypocalcaemia following total thyroidectomy and to evaluate the risk factors predicting delayed outcome such as hypoparathyroidism. From January 1998 to September 2001, 310 patients underwent total thyroidectomy in our department. In a total of 37 patients experiencing hypocalcaemia, the authors carried out a comparative study of 34 patients with transient hypocalcaemia (group A) and 3 patients with permanent hypocalcaemia (group B). The incidences of transient and permanent hypocalcaemia were 11.9% and 0.9%, respectively. Central neck lymph-node dissection performed in cases of thyroid carcinoma correlated with permanent hypoparathyroidism. The most significant factors predicting long-term outcome of hypocalcaemia were low serum calcium levels (< 8 mg/dl) and high serum phosphorus levels (> 5 mg/dl) measured on postoperative day 7, despite oral calcium replacement. The indications for lymph-node dissection in the central neck area should be very strictly selected. When delayed serum calcium and phosphorus levels are unfavourable, thorough follow-up of patients is mandatory in order to administer the correct therapy and prevent the consequences of chronic hypocalcaemia.
甲状腺全切除术后常可见术后低钙血症。在术后1年仍需补钙治疗的患者中，低钙血症必须被视为永久性的。本研究的目的是评估甲状腺全切除术后低钙血症的发生率，并评估预测延迟性结局（如甲状旁腺功能减退）的危险因素。1998年1月至2001年9月，我科共有310例患者接受了甲状腺全切除术。在总共37例发生低钙血症的患者中，作者对34例短暂性低钙血症患者（A组）和3例永久性低钙血症患者（B组）进行了对比研究。短暂性和永久性低钙血症的发生率分别为11.9%和0.9%。甲状腺癌患者行中央区颈部淋巴结清扫与永久性甲状旁腺功能减退相关。预测低钙血症长期结局的最显著因素是术后第7天尽管进行了口服补钙治疗，但血清钙水平仍较低（<8mg/dl）且血清磷水平较高（>5mg/dl）。中央区颈部淋巴结清扫的适应证应严格选择。当血清钙和磷的延迟水平不理想时，必须对患者进行全面随访，以便给予正确的治疗并预防慢性低钙血症的后果。
