Del Rio Paolo, Rossini Matteo, Montana Chiara Montana, Viani Lorenzo, Pedrazzi Giuseppe, Loderer Tommaso, Cozzani Federico
Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy.
Department of Medicine and Surgery, University of Parma, Parma, Italy.
BMC Surg. 2019 Apr 24;18(Suppl 1):25. doi: 10.1186/s12893-019-0483-y.
Early Hypocalcemia is the most frequent complication after thyroid surgery. Several studies have tried to identify factors (patient caracteristics or surgical technique variations) affecting hypocalcemia following thyroid surgery. This studiy evaluates the role of several factors in postoperative hypocalcemia development.
A retrospective study conducted on 2108 patients that underwent thyroid surgery in a single center (1669 women and 439 men). Postoperative early hypocalcemia was defined as serum calcium levels lower than 8,0 mg/dl measured 24 h after surgery. Following factors were evaluated in the study: sex, age, glandular hyperfunction, preoperative diagnosis, preoperative serum calcium levels, preoperative serum PTH levels, type of surgery performed (total thyroidectomy vs. lobectomy); minimally invasive video assisted thyroidectomy (MIVAT); number of parathyroid preserved in situ, postoperative serum calcium levels, changes in perioperative calcium levels (difference between preoperative values and postoperative calcium levels), presence of carcinoma in the surgical specimen, presence of thyroiditis based on histopatology reports.
Among evaluated factors only gender and surgical procedure revealed to be significantly correlated to early hypocalcemia development. In fact female patients experienced postoperative hypocalcemia in 42% (701/1669) of cases, which was signicantly higher than the 21.4% (94/439) identified in men. We also noticed a greater hypocalcemia incidence in patient undergoing total thyroidectomy (38.8%) than in patient undergoing lobectomy group (13.8%). Early hypocalcemia development didn't appear to be related to preoperative serum calcium levels but it showed a statistically significant correlation with perioperative serum calcium level drop.
This findings suggest that sex (female gender is a strong risk factor),surgical procedure and perioperative changes in serum calcium are the only factors (among all variables examined) that influence early hypocalcemia development.
早期低钙血症是甲状腺手术后最常见的并发症。多项研究试图确定影响甲状腺手术后低钙血症的因素（患者特征或手术技术差异）。本研究评估了多个因素在术后低钙血症发生中的作用。
对在单一中心接受甲状腺手术的2108例患者进行回顾性研究（1669例女性和439例男性）。术后早期低钙血症定义为术后24小时测得的血清钙水平低于8.0mg/dl。本研究评估了以下因素：性别、年龄、腺体功能亢进、术前诊断、术前血清钙水平、术前血清甲状旁腺激素水平、所施行的手术类型（全甲状腺切除术与叶切除术）；微创视频辅助甲状腺切除术（MIVAT）；原位保留甲状旁腺的数量、术后血清钙水平、围手术期钙水平的变化（术前值与术后钙水平的差值）、手术标本中是否存在癌、根据组织病理学报告是否存在甲状腺炎。
在评估的因素中，只有性别和手术方式与早期低钙血症的发生显著相关。事实上，女性患者术后低钙血症发生率为42%（701/1669），显著高于男性患者的21.4%（94/439）。我们还注意到，接受全甲状腺切除术的患者低钙血症发生率（38.8%）高于接受叶切除术组的患者（13.8%）。早期低钙血症的发生似乎与术前血清钙水平无关，但与围手术期血清钙水平下降具有统计学显著相关性。
这些发现表明，性别（女性是一个强风险因素）、手术方式和血清钙的围手术期变化是（在所有检查变量中）影响早期低钙血症发生的唯一因素。
