Liu Jun, Fan Xue-Feng, Yang Meng, Huang Lin-Ping, Zhang Ling
Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Department of General Surgery, Shougang General Hospital, Shougang 553000, Guizhou Province, China.
World J Clin Cases. 2022 May 6;10(13):4033-4041. doi: 10.12998/wjcc.v10.i13.4033.
Severe hypocalcemia (SH) is a dreaded complication of total parathyroidectomy (TPTX) without auto-transplantation.
To compare conventional and preventive calcium supplementation (CS) regimens in terms of SH occurrence after TPTX.
This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital. From January 2015 to May 2016, conventional CS was performed in patients who underwent TPTX, with calcium amounts adjusted according to postoperative serum calcium levels. From October 2016 to May 2018, preventive CS was performed according to preoperative alkaline phosphatase (ALP) levels. The patients were defined as low-risk (ALP < 500 U/L) and high-risk (ALP > 500 U/L) for SH. All preoperative blood samples were collected in the fasting state on the day before surgery. Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.
A total of 271 patients were included. These patients were 47.7 ± 11.1 years old, and 57.6% were male. Their mean body mass index (BMI) was 22.9 ± 3.8 kg/m. There were no significant differences in sex, age, BMI, preoperative ALP, serum calcium, serum phosphorus, calcium-phosphorus ratio, and intact parathyroid hormone (iPTH) between the two CS groups. Compared with conventional CS, preventive CS led to lower occurrence rates of hypocalcemia within 48 h (46.0% 74.5%, < 0.001) and SH (31.7% 64.1%, < 0.001). Multivariable analysis showed that preoperative iPTH levels [odds ratio (OR) = 1.001, 95% confidence interval (CI): 1.000-1.001, = 0.009), preoperative ALP amounts (OR = 1.002, 95%CI: 1.001-1.003, = 0.002), preoperative serum phosphorus levels (OR = 8.729, 95%CI: 1.518-50.216, = 0.015) and preventive CS (OR = 0.132, 95%CI: 0.067-0.261, < 0.001) were independently associated with SH. In patients with preoperative ALP ≥ 500 U/L, only preventive CS (OR = 0.147, 95%CI: 0.038-0.562. = 0.005) was independently associated with SH.
This study suggests that preventive CS could reduce the occurrence of SH, indicating its critical value for hypocalcemia after TPTX.
严重低钙血症（SH）是未进行自体移植的甲状旁腺全切术（TPTX）的一种可怕并发症。
比较常规补钙方案和预防性补钙方案在TPTX术后SH发生情况方面的差异。
这项回顾性研究纳入了2015年1月至2018年5月在中国医学科学院肿瘤医院接受TPTX的患者。2015年1月至2016年5月，对接受TPTX的患者采用常规补钙，根据术后血清钙水平调整钙的用量。2016年10月至2018年5月，根据术前碱性磷酸酶（ALP）水平进行预防性补钙。将患者分为SH低风险组（ALP<500 U/L）和高风险组（ALP>500 U/L）。所有术前血样均在手术前一天的空腹状态下采集。术后血样于术后第一天早上6-7点采集。
共纳入271例患者。这些患者的年龄为47.7±11.1岁，57.6%为男性。他们的平均体重指数（BMI）为22.9±3.8 kg/m²。两组补钙方案在性别、年龄、BMI、术前ALP、血清钙、血清磷、钙磷比和完整甲状旁腺激素（iPTH）方面无显著差异。与常规补钙相比，预防性补钙导致48小时内低钙血症（46.0%比74.5%，P<0.001）和SH（31.7%比64.1%，P<0.001）的发生率更低。多变量分析显示，术前iPTH水平[比值比（OR）=1.001，95%置信区间（CI）：1.000-1.001，P=0.009]、术前ALP量（OR=1.002，95%CI：1.001-1.003，P=0.002）、术前血清磷水平（OR=8.729，95%CI：1.518-50.216，P=0.015）和预防性补钙（OR=0.132，95%CI：0.067-0.261，P<0.001）与SH独立相关。在术前ALP≥500 U/L的患者中，只有预防性补钙（OR=0.147，95%CI：0.038-0.562，P=0.005）与SH独立相关。
本研究表明，预防性补钙可降低SH的发生率，提示其对TPTX术后低钙血症具有重要价值。
