Stewart Zoe A, Blackford Amanda, Somervell Helina, Friedman Kent, Garrett-Mayer Elizabeth, Dackiw Alan P B, Zeiger Martha A
Division of Endocrine and Oncologic Surgery, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
Surgery. 2005 Dec;138(6):1018-25; discussion 1025-6. doi: 10.1016/j.surg.2005.09.018.
Patients with primary hyperparathyroidism who undergo minimally invasive parathyroidectomy (MIP) may have postoperative symptoms of hypocalcemia or secondary hyperparathyroidism. This study sought to identify factors predictive of these events.
Between 1998 and 2004, 190 patients with primary hyperparathyroidism underwent MIP with excision of a single adenoma. Age, gender, race, prior head and neck surgery, use of preoperative thyroid hormone or calcium-channel blockers, preoperative levels of calcium, 25-hydroxyvitamin D (25[OH]D) and intact parathyroid hormone (iPTH), the presence of osteopenia or osteoporosis, intraoperative iPTH levels, and adenoma weight were evaluated by univariate analysis as predictors of postoperative symptoms of hypocalcemia and secondary hyperparathyroidism.
None of the following were predictors of postoperative symptoms of hypocalcemia: age, gender, race, prior head and neck surgery, preoperative medications, preoperative calcium and iPTH levels, osteopenia or osteoporosis, intraoperative iPTH levels, or adenoma weight. However, patients with postoperative symptoms of hypocalcemia had significantly lower preoperative 25[OH]D levels (P = .01). Further, higher preoperative iPTH levels (P < .01) and lower preoperative 25[OH]D levels (P = .05) were associated with secondary hyperparathyroidism postoperatively.
A low preoperative 25[OH]D level is associated with postoperative symptoms of hypocalcemia and secondary hyperparathyroidism in patients undergoing MIP. One might consider instituting empiric calcium supplementation postoperatively in patients with low 25[OH]D levels.
接受微创甲状旁腺切除术（MIP）的原发性甲状旁腺功能亢进患者术后可能出现低钙血症或继发性甲状旁腺功能亢进症状。本研究旨在确定这些事件的预测因素。
1998年至2004年间，190例原发性甲状旁腺功能亢进患者接受了MIP，切除单个腺瘤。通过单因素分析评估年龄、性别、种族、既往头颈手术史、术前甲状腺激素或钙通道阻滞剂的使用情况、术前钙、25-羟维生素D（25[OH]D）和完整甲状旁腺激素（iPTH）水平、骨质减少或骨质疏松的存在、术中iPTH水平以及腺瘤重量，作为术后低钙血症和继发性甲状旁腺功能亢进症状的预测因素。
以下因素均不是术后低钙血症症状的预测因素：年龄、性别、种族、既往头颈手术史、术前用药、术前钙和iPTH水平、骨质减少或骨质疏松、术中iPTH水平或腺瘤重量。然而，术后有低钙血症症状的患者术前25[OH]D水平显著较低（P = 0.01）。此外，术前较高的iPTH水平（P < 0.01）和较低的术前25[OH]D水平（P = 0.05）与术后继发性甲状旁腺功能亢进相关。
术前25[OH]D水平低与接受MIP的患者术后低钙血症和继发性甲状旁腺功能亢进症状相关。对于25[OH]D水平低的患者，可考虑术后经验性补钙。
