胃肠外科手术、吸收不良状况以及颈部手术后的低钙血症。
Gastrointestinal surgery, malabsorptive conditions, and postoperative hypocalcemia after neck surgery.
作者信息
Passman Jesse E, Ginzberg Sara, Gasior Julia A, Krumeich Lauren, Brensinger Colleen, Bader Amanda, Hwang Jasmine, Kelz Rachel, Wachtel Heather
机构信息
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: https://twitter.com/SaraGinzbergMD.
出版信息
Surgery. 2025 Jan;177:108905. doi: 10.1016/j.surg.2024.08.057. Epub 2024 Oct 28.
BACKGROUND
Postoperative hypocalcemia is a common complication of thyroid and parathyroid surgery. Patients with prior gastric bypass face increased risk of postoperative hypocalcemia, but the impact of other malabsorptive conditions is not well understood. In this study, we evaluated the relationship between multiple medical and surgical malabsorptive states and hypocalcemia after thyroid and parathyroid surgery.
METHODS
We performed a retrospective cohort study of patients who underwent total thyroidectomy and/or parathyroidectomy in Optum's deidentified Clinformatics Data Mart Database (2004-2022). Patients were categorized as having surgical (foregut/midgut: gastrectomy, intestinal bypass, enterectomy, enterostomy, pancreatectomy, or hindgut: colectomy/colostomy) or medical (Crohn or Celiac disease) malabsorptive conditions. The primary outcomes were early (<7 days) and late (7-365 days) postoperative hypocalcemia. Logistic regression was performed to determine the associations between malabsorptive conditions and outcomes.
RESULTS
Of 25,400 patients (56.9% total thyroidectomy, 40.8% parathyroidectomy, and 2.4% both procedures), 4.0% had a pre-existing malabsorptive condition. Early postoperative hypocalcemia occurred in 8.8% of patients, and late hypocalcemia in 18.3%. Thyroidectomy was associated with a greater likelihood of hypocalcemia than parathyroidectomy (odds ratio: 1.22; P < .001). Pancreatectomy was associated with twice the adjusted odds of postoperative hypocalcemia (odds ratio: 2.27; P = .031) across both procedures. Patients with prior foregut/midgut surgery were at higher risk after total thyroidectomy (odds ratio: 1.65, P = .002). This association was significant in late (odds ratio: 1.82, P < .001) rather than early hypocalcemia (odds ratio: 1.33, P = .175). Hindgut surgery and medical malabsorption did not demonstrate such associations.
CONCLUSION
Prior foregut and midgut resections may predispose patients to postoperative hypocalcemia, particularly in patients undergoing total thyroidectomy.
背景
术后低钙血症是甲状腺和甲状旁腺手术常见的并发症。既往接受过胃旁路手术的患者术后发生低钙血症的风险增加，但其他吸收不良情况的影响尚不清楚。在本研究中，我们评估了多种内科和外科吸收不良状态与甲状腺和甲状旁腺手术后低钙血症之间的关系。
方法
我们在Optum的去识别化临床信息数据集市数据库（2004 - 2022年）中对接受全甲状腺切除术和/或甲状旁腺切除术的患者进行了一项回顾性队列研究。患者被分类为患有外科（前肠/中肠：胃切除术、肠旁路术、肠切除术、肠造口术、胰腺切除术，或后肠：结肠切除术/结肠造口术）或内科（克罗恩病或乳糜泻）吸收不良情况。主要结局是术后早期（<7天）和晚期（7 - 365天）低钙血症。进行逻辑回归以确定吸收不良情况与结局之间的关联。
结果
在25400例患者中（56.9%为全甲状腺切除术，40.8%为甲状旁腺切除术，2.4%为两种手术均做），4.0%的患者存在既往吸收不良情况。术后早期低钙血症发生在8.8%的患者中，晚期低钙血症发生在18.3%的患者中。甲状腺切除术比甲状旁腺切除术发生低钙血症的可能性更大（比值比：1.22；P <.001）。在两种手术中，胰腺切除术与术后低钙血症调整后的比值比增加两倍相关（比值比：2.27；P =.031）。既往有前肠/中肠手术史的患者在全甲状腺切除术后风险更高（比值比：1.65，P =.002）。这种关联在晚期（比值比：1.82，P <.001）而非早期低钙血症（比值比：1.33，P =.175）中显著。后肠手术和内科吸收不良未显示出此类关联。
结论
既往前肠和中肠切除术可能使患者易发生术后低钙血症，尤其是在接受全甲状腺切除术的患者中。
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