Wong C, Price S, Scott-Coombes D
Department of Surgery, Frenchay Hospital, Frenchay Park, Bristol, BS16 1LE, UK.
World J Surg. 2006 May;30(5):825-32. doi: 10.1007/s00268-005-0478-y.
Ambulatory surgery (23:59-hour hospital stay) is gaining popularity in endocrine surgery. Hypocalcaemia is common following total thyroidectomy. Identifying patients with low risk of hypocalcaemia may facilitate early discharge (24-hour stay).
We conducted a prospective study including all patients undergoing total thyroidectomy. Blood samples were taken immediately following skin closure and the following morning for parathyroid hormone (PTH) and calcium measurement. Calcium supplements were routinely given when serum calcium was below 2.0 mmol/l.
Thirty patients (27 females, 3 males) underwent total thyroidectomy (including 4 nodal dissection) for multinodular goitre (14), Graves' disease (11), papillary (4) and follicular (1) thyroid carcinoma. Twelve patients developed symptomatic transient hypocalcaemia. Based on morning calcium of < 2.0 mmol/l as trigger for calcium supplementation, 8 patients received calcium supplement with 4 false negatives, resulting in a specificity of 94.4%, sensitivity of 66.7%, positive predictive value (PPV) of 88.9% and negative predictive value (NPV) of 81%. Based on PTH levels (< 1.5 pmol/l) immediately following skin closure, 11 patients would receive calcium supplement, with 1 false negative resulting in a specificity of 83.3%, sensitivity of 91.7%, PPV of 78.6% and NPV of 93.8%. If supplementation is based on PTH levels (< 1.5 pmol/l) immediately following skin closure and morning calcium level (< 2.0 mmol/l), all 12 symptomatic patients will be correctly treated, with 4 false positives resulting in a combined specificity of 77.8%, sensitivity of 100%, PPV of 75% and NPV of 100%.
Combining the immediate postoperation PTH levels (< 1.5 pmol/l) and morning serum calcium (< 2.0 mmol/l) can accurately identify patients at risk of hypocalcaemia following total thyroidectomy, allowing safe, early discharge.
门诊手术（住院时间23:59小时）在内分泌外科手术中越来越受欢迎。全甲状腺切除术后低钙血症很常见。识别低钙血症风险低的患者可能有助于早期出院（住院24小时）。
我们进行了一项前瞻性研究，纳入了所有接受全甲状腺切除术的患者。皮肤缝合后立即及术后次日早晨采集血样，检测甲状旁腺激素（PTH）和钙水平。血清钙低于2.0 mmol/L时常规给予补钙治疗。
30例患者（27例女性，3例男性）因多结节性甲状腺肿（14例）、格雷夫斯病（11例）、乳头状（4例）和滤泡状（1例）甲状腺癌接受了全甲状腺切除术（包括4例淋巴结清扫）。12例患者出现有症状的短暂性低钙血症。以术后次日早晨钙水平<2.0 mmol/L作为补钙的触发指标，8例患者接受了补钙治疗，其中4例假阴性，特异性为94.4%，敏感性为66.7%，阳性预测值（PPV）为88.9%，阴性预测值（NPV）为81%。以皮肤缝合后立即的PTH水平（<1.5 pmol/L）为依据，11例患者将接受补钙治疗，其中1例假阴性，特异性为83.3%，敏感性为91.7%，PPV为78.6%，NPV为93.8%。如果根据皮肤缝合后立即的PTH水平（<1.5 pmol/L）和术后次日早晨钙水平（<2.0 mmol/L）进行补钙，所有12例有症状的患者都将得到正确治疗，有4例假阳性，联合特异性为77.8%，敏感性为100%，PPV为75%，NPV为100%。
联合术后立即的PTH水平（<1.5 pmol/L）和术后次日早晨血清钙水平（<2.0 mmol/L）可以准确识别全甲状腺切除术后有低钙血症风险的患者，实现安全、早期出院。
