甲状腺手术后的偶然甲状旁腺切除术：一项单中心研究。

Incidental Parathyroidectomy After Thyroid Surgery: A Single-Center Study.

作者信息

Granata Roberta, Zanghì Antonio, Scribano Marianna, Riccioli Giordana, Privitera Francesca, La Vignera Sandro, Condorelli Rosita Angela, Leonforte Francesco, Mistretta Antonio, Calogero Aldo Eugenio, Veroux Massimiliano

机构信息

General Surgery Unit, Azienda Policlinico San Marco, University of Catania, 95124 Catania, Italy.

Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy.

出版信息

Biomedicines. 2024 Oct 17;12(10):2372. doi: 10.3390/biomedicines12102372.

DOI:10.3390/biomedicines12102372

PMID:39457684

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11505326/

Abstract

BACKGROUND

Hypoparathyroidism with hypocalcemia is the most frequent complication after thyroid surgery. Many risk factors have been involved in the development of this complication, with conflicting results. Incidental parathyroidectomy (IP) may be a frequent cause of postoperative hypocalcemia. In this study, we have evaluated the risk factors associated with the IP in a single-center cohort of patients undergoing thyroid surgery.

PATIENTS AND METHODS

The incidence and the risk factors for IP were evaluated in 799 patients scheduled for surgical treatment for thyroid disease between January 2018 and December 2023. Parathyroid hormone levels and serum calcium levels, together with the histological specimens, were evaluated in all patients.

RESULTS

Post-operative temporary hypocalcemia was present in 239 (29.9%) patients. A total of 144 patients (21.9%) had an incidental parathyroidectomy. Younger patients (<40 years) had the highest risk of having an incidental parathyroidectomy (RR 1.53 (95% CI 1.084-2.161), OR 1.72 (95% CI 1.091-2.710), = 0.014). Moreover, thyroid cancer (RR 1.4 (95 CI 1.114-1.882) OR 1.68 (95% CI 1.145-2.484), < 0.05) and the neck dissection (RR 1.75 (95% CI 1.409-2.198) OR 2.38 (95% CI 1.644-3.460), < 0.001) were strongly associated with the risk of incidental parathyroidectomy.

CONCLUSIONS

Younger female patients with thyroid cancer and neck dissection were at the highest risk of incidental parathyroidectomy. A meticulous surgical dissection, together with imaging methods for the detection of the parathyroid glands, may reduce the incidence of this complication.

摘要

背景

甲状旁腺功能减退伴低钙血症是甲状腺手术后最常见的并发症。许多危险因素与该并发症的发生有关，但结果相互矛盾。意外甲状旁腺切除术（IP）可能是术后低钙血症的常见原因。在本研究中，我们评估了单中心队列中接受甲状腺手术患者发生IP的相关危险因素。

患者与方法

对2018年1月至2023年12月期间计划接受甲状腺疾病手术治疗的799例患者进行了IP的发生率及危险因素评估。对所有患者评估甲状旁腺激素水平、血清钙水平以及组织学标本。

结果

239例（29.9%）患者术后出现暂时性低钙血症。共有144例患者（21.9%）进行了意外甲状旁腺切除术。年轻患者（<40岁）发生意外甲状旁腺切除术的风险最高（相对危险度1.53（95%置信区间1.084 - 2.161），比值比1.72（95%置信区间1.091 - 2.710），P = 0.014）。此外，甲状腺癌（相对危险度1.4（95%置信区间1.114 - 1.882），比值比1.68（95%置信区间1.145 - 2.484），P < 0.05）和颈部清扫术（相对危险度1.75（95%置信区间1.409 - 2.198），比值比2.38（95%置信区间1.644 - 3.460），P < 0.001）与意外甲状旁腺切除术的风险密切相关。