Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland.
Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland.
Br J Surg. 2022 Nov 22;109(12):1198-1205. doi: 10.1093/bjs/znac310.
Hypocalcaemia is a common complication after thyroidectomy. Bariatric surgery is associated with significant changes in calcium metabolism. Some studies have identified bariatric surgery as a risk factor for hypocalcaemia after thyroidectomy. This systematic review and meta-analysis assessed whether a history of bariatric surgery was associated with an increased risk of hypocalcaemia after thyroidectomy.
This prospectively registered systematic review (PROSPERO; CRD42021295423) was performed in accordance with PRISMA guidelines. Meta-analysis was undertaken using the Mantel-Haenszel method, with outcomes reported as ORs with 95 per cent confidence intervals.
Twenty studies were included in the qualitative synthesis. Five studies incorporating 19 547 patients met the inclusion criteria for meta-analysis, of whom 196 (1.0 per cent) had a history of bariatric surgery. Patients with a history of bariatric surgery were more likely to develop hypocalcaemia after thyroidectomy (30.6 versus 13.0 per cent; OR 3.90, 95 per cent c.i. 1.50 to 10.12; P = 0.005). Among those with a history of bariatric surgery, patients who underwent a bypass procedure were more likely to develop hypocalcaemia after thyroidectomy than those who had a restrictive procedure (38 versus 23 per cent; OR 2.12, 1.14 to 3.97; P = 0.020).
Patients with a history of bariatric surgery have a significantly greater risk of hypocalcaemia after thyroidectomy, with a heightened risk among those who have had a bypass procedure. Surgeons performing thyroid surgery should be aware of the increased risk of hypocalcaemia after thyroidectomy among these patients.
甲状旁腺功能减退症是甲状腺手术后的常见并发症。减重手术与钙代谢的显著变化有关。一些研究已经确定减重手术是甲状腺手术后甲状旁腺功能减退症的危险因素。本系统评价和荟萃分析评估了减重手术史是否与甲状腺手术后甲状旁腺功能减退症的风险增加有关。
本前瞻性注册系统评价（PROSPERO；CRD42021295423）按照 PRISMA 指南进行。使用 Mantel-Haenszel 法进行荟萃分析，结果以 95%置信区间的 OR 报告。
20 项研究纳入定性综合分析。5 项纳入 19547 例患者的研究符合荟萃分析纳入标准，其中 196 例（1.0%）有减重手术史。有减重手术史的患者在甲状腺手术后更有可能发生甲状旁腺功能减退症（30.6%比 13.0%；OR 3.90，95%置信区间 1.50 至 10.12；P=0.005）。在有减重手术史的患者中，接受旁路手术的患者在甲状腺手术后发生甲状旁腺功能减退症的可能性高于接受限制性手术的患者（38%比 23%；OR 2.12，1.14 至 3.97；P=0.020）。
有减重手术史的患者在甲状腺手术后发生甲状旁腺功能减退症的风险显著增加，旁路手术后的风险更高。进行甲状腺手术的外科医生应意识到这些患者在甲状腺手术后发生甲状旁腺功能减退症的风险增加。
