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甲状腺切除术后低钙血症的预测因素。

Predictors factors for post-thyroidectomy hypocalcaemia.

作者信息

Sousa Alexandre de Andrade, Salles José Maria Porcaro, Soares João Marcos Arantes, Moraes Gustavo Meyer de, Carvalho Jomar Rezende, Savassi-Rocha Paulo Roberto

机构信息

Faculty of Medicine of the Federal University of Minas Gerais, and Alfa Institute of Gastroenterology, UFMGClinics Hospital, Minas Gerais – MG, Brazil.

出版信息

Rev Col Bras Cir. 2012 Dec;39(6):476-82. doi: 10.1590/s0100-69912012000600006.

Abstract

OBJECTIVE

To evaluate the incidence and predictors of post-thyroidectomy definitive hypocalcemia and hypoparathyroidism.

METHODS

We assessed ionic calcium preoperatively and postoperatively (first, second and 30th day) in 333 patients undergoing thyroidectomy. In those presenting hypocalcemia, measurements were also made 90 and 180 days after surgery, when parathormone was also dosed. Patients were grouped according to the presence or absence of hypocalcemia and evaluated according to age, gender, thyroid function, thyroid volume, number of parathyroid glands identified and need to parathyroid reimplantation, type of operation, operative time, and histopathological diagnosis.

RESULTS

The incidence of temporary hypocalcemia was 40.8% (136 patients), and of definitive hypoparathyroidism 4.2% (14 patients). Reoperation or total thyroidectomy, neck dissection, hyperthyroidism, operative time and age above 50 years were factors related to higher incidence of hypocalcemia and definitive hypoparathyroidism (p <0.05).

CONCLUSION

predictors of postoperative hypocalcemia included age (> 50 years), total thyroidectomy, reoperation, neck dissection and operative time. The predictors of post-thyroidectomy definitive hypoparathyroidism included type of operation, histological diagnosis and hyperthyroidism.

摘要

目的

评估甲状腺切除术后永久性低钙血症和甲状旁腺功能减退的发生率及预测因素。

方法

我们对333例行甲状腺切除术的患者术前及术后(第1天、第2天和第30天)的离子钙水平进行了评估。对于出现低钙血症的患者,在术后90天和180天也进行了测量,同时检测甲状旁腺激素水平。根据是否存在低钙血症对患者进行分组,并根据年龄、性别、甲状腺功能、甲状腺体积、识别出的甲状旁腺数量及甲状旁腺再植需求、手术类型、手术时间和组织病理学诊断进行评估。

结果

暂时性低钙血症的发生率为40.8%(136例患者),永久性甲状旁腺功能减退的发生率为4.2%(14例患者)。再次手术或全甲状腺切除术、颈部清扫术、甲状腺功能亢进、手术时间以及年龄大于50岁是与低钙血症和永久性甲状旁腺功能减退发生率较高相关的因素(p<0.05)。

结论

术后低钙血症的预测因素包括年龄(>50岁)、全甲状腺切除术、再次手术、颈部清扫术和手术时间。甲状腺切除术后永久性甲状旁腺功能减退的预测因素包括手术类型、组织学诊断和甲状腺功能亢进。

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