Puzziello Alessandro, Rosato Lodovico, Innaro Nadia, Orlando Giulio, Avenia Nicola, Perigli Giuliani, Calò Pietro G, De Palma Maurizio
Department of General Surgery, San Giovanni di Dio e Ruggi d'Aragona Hospital, University of Salerno, Salerno, Italy,
Endocrine. 2014 Nov;47(2):537-42. doi: 10.1007/s12020-014-0209-y. Epub 2014 Feb 22.
Postoperative hypocalcemia is the most frequent complication of total thyroidectomy. It may have a delayed onset, and therefore delays the discharge from the hospital, requiring calcium replacement therapy to alleviate clinical symptoms. During a 7-month period, 2,631 consecutive patients undergoing primary or completion thyroidectomy were prospectively followed up and underwent analysis regarding postoperative hypoparathyroidism. Data were prospectively collected by questionnaires from 39 Italian endocrine surgery units affiliated to the Italian Endocrine Surgery Units Association (Club delle Unità di EndocrinoChirurgia-UEC), where thyroid surgery is routinely performed. The incidence of hypoparathyroidism was 28.8 % (757 patients), including transient hypocalcemia (27.9 %-734 patients) and permanent hypocalcemia (0.9 %-23 patients). The rate of asymptomatic hypocalcemia was 70.80 %. The incidence of permanent hypocalcemia was higher in the symptomatic hypocalcemia group (7.5 %) than in asymptomatic one (1.5 %). Female patients experienced a transient postoperative hypocalcemia more frequently than male patients (29.7 and 21.2 %, respectively; p < 0.0001). The percentage developing hypocalcemia in patients in which parathyroid glands were intraoperatively identified and preserved was higher than in the patients in which the identification of parathyroid glands was not achieved (29.2 vs. 18.7 %, p < 0.01). This prospective study confirmed the main risk factors for postoperative hypocalcemia: thyroid cancer, nodal dissection, and female gender. It farther showed that identifying parathyroids has an important role to prevent permanent hypocalcemia though with a higher risk of transient hypocalcemia. A suitable informed consent should especially emphasize the importance of some primary factors in increasing the risk of hypocalcemia after thyroid surgery.
术后低钙血症是全甲状腺切除术后最常见的并发症。其发病可能延迟，从而导致患者出院延迟，需要进行补钙治疗以缓解临床症状。在7个月的时间里，对2631例连续接受初次或再次甲状腺切除术的患者进行了前瞻性随访，并对术后甲状旁腺功能减退情况进行了分析。数据通过问卷前瞻性收集自隶属于意大利内分泌外科单位协会（意大利内分泌外科俱乐部 - UEC）的39个意大利内分泌外科单位，这些单位常规开展甲状腺手术。甲状旁腺功能减退的发生率为28.8%（757例患者），包括短暂性低钙血症（27.9% - 734例患者）和永久性低钙血症（0.9% - 23例患者）。无症状性低钙血症的发生率为70.80%。有症状的低钙血症组中永久性低钙血症的发生率（7.5%）高于无症状组（1.5%）。女性患者术后短暂性低钙血症的发生率高于男性患者（分别为29.7%和21.2%；p < 0.0001）。术中识别并保留甲状旁腺的患者发生低钙血症的百分比高于未成功识别甲状旁腺的患者（29.2%对18.7%，p < 0.01）。这项前瞻性研究证实了术后低钙血症的主要危险因素：甲状腺癌、淋巴结清扫和女性性别。研究还进一步表明，识别甲状旁腺对预防永久性低钙血症具有重要作用，尽管发生短暂性低钙血症的风险较高。一份合适的知情同意书应特别强调某些主要因素在增加甲状腺手术后低钙血症风险方面的重要性。
