甲状腺全切术后意外甲状旁腺切除对术后血钙水平的影响。
Effect of incidental parathyroidectomy on postoperative calcium levels after to-tal thyroidectomy.
作者信息
Doulaptsi M, Ierodiakonou D, Prokopakis E, Stanitsa N, Rogdakis A, Karatzanis A
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece.
Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece.
出版信息
Hippokratia. 2020 Apr-Jun;24(2):72-76.
BACKGROUND
Incidental parathyroidectomy during total thyroidectomy may occur even in the most experienced hands. This study aims to assess the incidence, risk factors, and impact of incidental parathyroidectomy on this very targeted group of patients.
METHODS
Three hundred and four consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively studied. Based on the histopathology report, incidental parathyroidectomy was assessed in relation to postoperative transient/permanent hypocalcemia. Demographic, clinical, and histological data were analyzed.
RESULTS
The overall incidence of unintentional removal of parathyroid glands during total thyroidectomy was 35.5 %. Indicators were the postoperative hypocalcemia, the percent change of parathormone serum levels, and the presence of lymph nodes in the histopathology report. Patients with incidental parathyroidectomy exhibited a higher incidence of transient hypocalcemia and hypoparathyroidism postoperatively.
CONCLUSIONS
Incidental parathyroidectomy is associated with transient hypocalcemia after total thyroidectomy. Even single parathyroid in the histopathology specimen may be sufficient for influencing postoperative PTH levels and calcium. Every effort should be made by surgeons to identify and protect all parathyroid glands successfully. HIPPOKRATIA 2020, 24(2): 72-76.
背景
即使是经验最丰富的医生，在全甲状腺切除术中也可能发生意外甲状旁腺切除术。本研究旨在评估意外甲状旁腺切除术在这一特定患者群体中的发生率、危险因素及影响。
方法
前瞻性研究了一家三级转诊中心连续进行全甲状腺切除术的304例病例。根据组织病理学报告，评估意外甲状旁腺切除术与术后短暂性/永久性低钙血症的关系。分析了人口统计学、临床和组织学数据。
结果
全甲状腺切除术中意外切除甲状旁腺的总体发生率为35.5%。指标包括术后低钙血症、甲状旁腺激素血清水平的变化百分比以及组织病理学报告中淋巴结的存在情况。意外甲状旁腺切除术患者术后短暂性低钙血症和甲状旁腺功能减退的发生率较高。
结论
意外甲状旁腺切除术与全甲状腺切除术后的短暂性低钙血症有关。即使组织病理学标本中仅有单个甲状旁腺，也可能足以影响术后甲状旁腺激素水平和钙水平。外科医生应尽一切努力成功识别并保护所有甲状旁腺。《希波克拉底》2020年，第24卷第2期：72 - 76页。
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