Yu Yangyang R, Fallon Sara C, Carpenter Jennifer L, Athanassaki Ioanna, Brandt Mary L, Wesson David E, Lopez Monica E
Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030.
Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital, Houston, TX 77030.
J Pediatr Surg. 2017 May;52(5):684-688. doi: 10.1016/j.jpedsurg.2017.01.011. Epub 2017 Jan 27.
We seek to identify risk factors associated with hypocalcemia after pediatric total thyroidectomy.
We retrospectively reviewed patients younger than 21years undergoing total thyroidectomy between January 2002 and January 2016. We defined hypocalcemia as any serum calcium <8mg/dl or ionized calcium <1.0mmol/L. Perioperative risk factors were identified through multivariate logistic regression.
Ninety-one children underwent total thyroidectomy. The average age was 13.7±4.4years, and 77% were female. Transient hypocalcemia was diagnosed in 34% (n=31) of patients. There was one case of permanent hypoparathyroidism. Predictors of transient hypocalcemia included age (OR 0.87, 95% CI 0.8-0.97, p=0.01), lymphadenectomy (OR 6.6, 95% CI 1.7-31.6, p=0.01), and hyperthyroidism (OR 13.3, 95% CI 1.3-1849, p=0.03). Patients with malignancy undergoing central (OR 7.1, 95% CI 1.5-33.4, p=0.01) or central plus lateral lymphadenectomy (OR 6.33, 95% CI 1.0-40.1, p=0.05) had significantly increased risk for transient hypocalcemia. Malignancy, MEN2A/B, goiter, preoperative calcium supplementation, incidental parathyroid removal, and postoperative PTH <15pg/ml were not associated with transient hypocalcemia.
Younger age, hyperthyroidism, and concomitant lymphadenectomy during total thyroidectomy increase risk of developing transient hypocalcemia. Malignant cases with central or central plus lateral lymphadenectomy are also at increased risk. Aggressive perioperative management of hypocalcemia should be initiated in patients with these risk factors.
2b.
我们试图确定小儿全甲状腺切除术后低钙血症的相关危险因素。
我们回顾性分析了2002年1月至2016年1月期间接受全甲状腺切除术的21岁以下患者。我们将低钙血症定义为血清钙<8mg/dl或离子钙<1.0mmol/L。通过多因素逻辑回归确定围手术期危险因素。
91名儿童接受了全甲状腺切除术。平均年龄为13.7±4.4岁，77%为女性。34%（n=31）的患者被诊断为短暂性低钙血症。有1例永久性甲状旁腺功能减退。短暂性低钙血症的预测因素包括年龄（比值比0.87，95%置信区间0.8 - 0.97，p=0.01）、淋巴结清扫术（比值比6.6，95%置信区间1.7 - 31.6，p=0.01）和甲状腺功能亢进（比值比13.3，95%置信区间1.3 - 1849，p=0.03）。患有恶性肿瘤且接受中央（比值比7.1，95%置信区间1.5 - 33.4，p=0.01）或中央加侧方淋巴结清扫术（比值比6.33，95%置信区间1.0 - 40.1，p=0.05）的患者发生短暂性低钙血症的风险显著增加。恶性肿瘤、MEN2A/B、甲状腺肿、术前补钙、意外甲状旁腺切除以及术后甲状旁腺激素<15pg/ml与短暂性低钙血症无关。
年龄较小、甲状腺功能亢进以及全甲状腺切除术中同时进行淋巴结清扫术会增加发生短暂性低钙血症的风险。进行中央或中央加侧方淋巴结清扫术的恶性病例风险也会增加。对于有这些危险因素的患者，应在围手术期积极进行低钙血症的管理。
2b。
