甲状腺手术中甲状旁腺误切和术后低钙血症

目的分析常见甲状腺手术时甲状旁腺误切和术后患者发现低钙血症之间的关系。方法回顾性分析126例甲状腺手术患者的临床资料,其中双侧腺叶大部切除术18例,一侧或双侧腺叶全切术74例和六区清扫术34例。结果 126例患者中,共有25例（19.8%）病理证实存在旁腺误切,有30例（23.8%）术后出现低钙血症,25例（19.8%）出现低钙临床表现,经治疗后症状在2 d内消失。低钙血症的发生（23.8%）和旁腺误切（19.8%）之间是相关的（r=0.87,P=0.0333）。随访6个月,低钙血症消失时间平均为4.25（1-12）周,没有患者出现永久性低钙血症。六区清扫术的总体旁腺误切率为41.2%（14/34）,高于大部切除术的5.6%（1/18）（P〈0.01）,亦高于腺叶全切除术的13.5%（10/74）（P=0.0013）。结论甲状腺腺叶切除及六区清扫术后短暂的低钙血症是比较常见的并发症;旁腺误切可以导致术后低钙血症的发生;六区清扫术有很高的旁腺误切风险。

Inadvertent Parathyroidectomy in Thyroid Surgery and Postoperative Hypocalcaemia

Objective To analyze the incidence of inadvertent parathyroidectomy in thyroid surgery and its relationship of the postoperative hypocalcaemia.Methods The clinical data of 126 cases underwent thyroid surgery was retrospectively analyzed.The operation procedures of these cases include subtotal thyroidectomy of 18 cases,single or bilateral thyroidectomy of 74 cases,and level six lymphadenectomy of 34 cases.The postoperative hypocalcaemia and symptomatic cases were counted,the parathyroidectomy cases were affirmed by pathologic results,and the differences of these results in different operations were compared.Results In these 126 cases,parathyroidectomy was unintentionally performed in 25 cases（19.8%）.30 cases（23.8%） had experienced postoperative hypocalcaemia and 25（19.8%） suffered related symptoms.There were co-relation of the parathyroidectomy and the incidence of the postoperative hypocalcaemia（r=0.87,P=0.0333）.No permanent hypocalcaemia had been observed.The rate of the unintentional parathyroidectomy was significant higher of the level six lymphadenectomy group than that of the thyroidectomy group（P=0.0013）,and also higher than the subtotal thyroidectomy group（P〈0.01）.But the other two groups had no difference（P〉0.05）.Conclusions Postoperative hypocalcaemia is common in patients after thyroid surgery,and parathyroidectomy may account for it.Incidence of unintentional parathyroidectomy in operations of level six lymphadenectomy is a potential risk factor in the thyroid cancer surgery.