甲状腺手术后低钙血症386例临床分析

Hypocalcemia after thyroid surgery:a clinical analysis of 386 cases.

目的探讨甲状腺手术后低钙血症的发生规律和相关因素及治疗方法。方法对2001年1月至2006年1月收治的2357例行甲状腺手术病人,分析监测术后血清钙的变化。结果甲状腺手术后出现低钙血症386例,其中单侧腺叶次全切除术13例,均无症状;双侧腺叶全切术14例,一侧腺叶全切除并对侧腺叶次全切除术304例,双侧叶甲状腺次全切除术53例,一侧腺叶全切除并对侧部分切除术2例。专科医师手术出现低钙血症222例(11·8%,222/1886),非专科医师手术出现低钙血症164例(34·8%,164/471)。结论双侧叶甲状腺全切除、一侧腺叶全切除加对侧腺叶次全切除、双侧叶甲状腺次全切除术,包括再次或二次以上手术,术后易出现低钙血症。甲状腺手术引起低钙血症与医师经验有关。

Objective To investigate the rule, etiology and treatment of hypocalcemia after thyroid surgery. Methods The change of serum calcium was analyzed in 2 357 patients who received thyroid operation between January 2001 and January 2006. Results Three hundred and eighty-six cases developed hypocalcemia after operation. Of them, 13 eases were in subtotal thyroid lobectomy, 14 eases in total thymidectomy, 304 cases in unilateral lobectomy with contralateral subtotal lobectomy,53 cases in unilateral subtotal lobectomy with contralateral subtotal lobectomy,and 2 cases in unilateral lobeetomy with eontralateral partial thyroid lobectomy. Furthermore, Hypoealeemia included 222 cases （222/1886 ） in professional surgeons and 164 cases （64/471） in non-professional surgeons. Conclusion Hypocalcemia often occurs in total thyroidectomy and unilateral lobectomy or subtotal lobectomy, with contralateral subtotal lobectomy. The patient who has accepted unilateral subtotal lobectomy with contralateral subtotal lobectomy should be observed the level of serum cal- cium in three days at least after thyroid surgery. It is necessary to treat hypocalcemia. Hypocalcemia after thyroidectomy is related with experience of surgeons.