Del Rio Paolo, Iapichino Gioacchino, De Simone Belinda, Bezer Lamia, Arcuri MariaFrancesca, Sianesi Mario
Department of Surgical Science, University Hospital of Parma, Parma, Italy.
Ann Ital Chir. 2010 Nov-Dec;81(6):397-401.
Hypocalcaemia is the most frequent complication after total thyroidectomy. The incidence of postoperative hypocalcaemia is reported with different percentages in literature.
We report 227 patients undergoing surgery for benign thyroid disease. After obtaining patient's informed consent, we collected and analyzed prospectively the following data: calcium serum levels pre and postoperative in the first 24 hours after surgery according to sex, age, duration of surgery, number of parathyroids identified by the surgeon, surgical technique (open and minimally invasive video-assisted thyroidectomy, i.e., MIVAT). We have considered cases treated consecutively from the same two experienced endocrine surgeons. Hypocalcaemia is assumed when the value of serum calcium is below 7.5 mg/dL.
Pre-and post-operative mean serum calcium, with confidence intervals at 99% divided by sex, revealed a statistically significant difference in the ANOVA test (p < 0.01) in terms of incidence. Female sex has higher incidence of hypocalcemia. The evaluation of the mean serum calcium in pre-and post-operative period, with confidence intervals at 95%, depending on the number of identified parathyroid glands by surgeon, showed that the result is not correlated with values of postoperative serum calcium. Age and pre-and postoperative serum calcium values with confidence intervals at 99% based on sex of patients, didn't show statistically significant differences. We haven't highlighted a significant difference in postoperative hypocalcemia in patients treated with conventional thyroidectomy versus MIVAT.
A difference in pre- and postoperative mean serum calcium occurs in all patients surgically treated. The only statistical meaningful risk factor for hypocalcemia has been the female sex.
低钙血症是全甲状腺切除术后最常见的并发症。文献报道的术后低钙血症发生率存在不同百分比。
我们报告了227例接受良性甲状腺疾病手术的患者。在获得患者知情同意后，我们前瞻性地收集并分析了以下数据：根据性别、年龄、手术时长、外科医生识别的甲状旁腺数量、手术技术（开放手术和微创视频辅助甲状腺切除术，即MIVAT），记录术后24小时内术前和术后的血清钙水平。我们纳入了由同两位经验丰富的内分泌外科医生连续治疗的病例。当血清钙值低于7.5mg/dL时认定为低钙血症。
按性别划分，术前和术后平均血清钙的99%置信区间在方差分析中显示出发病率存在统计学显著差异（p<0.01）。女性低钙血症的发生率更高。根据外科医生识别的甲状旁腺数量，对术前和术后平均血清钙进行95%置信区间评估，结果显示与术后血清钙值无关。基于患者性别，年龄以及术前和术后血清钙值的99%置信区间未显示出统计学显著差异。我们未发现传统甲状腺切除术与MIVAT治疗患者术后低钙血症存在显著差异。
所有接受手术治疗的患者术前和术后平均血清钙均存在差异。低钙血症唯一具有统计学意义的风险因素是女性性别。
