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目的 探讨甲状腺癌手术后低钙血症的发生发展规律及治疗方法。方法 对65例因甲状腺癌而做甲状腺全切除或近全切除的病人进行术后随访，动态监测血清钙，磷，镁的变化。结果 65例病人均出现不同程度的低钙血症，其中无症状低钙血症发生率为81．5％，术后不需静脉补钙治疗。有症状低钙血症的发生率为18．5％，需静脉补钙治疗，1例病人发生永久性甲状旁腺功能低下。有症状低钙血症组血清钙浓度在术后第1，2，3，5天较无症状低钙血症组血清钙浓度明显降低（P＜0．05）。有症状低钙血症组血清磷浓度在术后第2，3天较无症状低钙血症组血清磷浓度明显增高（P＜0．05）。结论 （1）有症状低钙血症发生在手术后3天之内，甲状腺癌手术后3天应常规监测血钙，血磷和血镁，血钙低于1.81mmol/L，高度警惕低钙症状出现。（2）有症状低钙血症病人经及时补充钙剂后，症状迅速改善，并往往在术后7天内消失。（3）血钙的高低与甲状旁腺的保留量，甲状旁腺素的浓度似乎无必然联系。

The clinical analysis of hypocalcemia after thyroid carcinoma surgery

Objective To investigate the rule,etiology and treatment of hypocalcemia after thyroid carcinoma surgery. Methods Sixty-five thyroid carcinoma patients who received total or near-total thyroidectomy were observed and closely followed up.Results Eighty one point five percents of patients did not require intravenous calcium supplementation during the postoperative period,but transient asymptomatic hypocalcemia were demonstrated in these patients,18.5% of patients required intravenous calcium supplementation,one patient developed permanent hypoparathyroidism. The serum calcium concentrations in symptomatic hypocalcemia group were obviously lower than those in asymptomatic hypocalcemia group on the first,second,third and fifth postoperative day(P<0.05).The serum phosphate concentrations in symptomatic hypocalcemia group were obviously higher than those in asymptomatic hypocalcemia group on the second and third postoperative day(P<0.05).Conclusion (1)Symptomatic hypocalcemia were all found within three days after thyroid surgery. It is necessary to monitor the level of serum calcium, phosphate and magnesium in three days after thyroid surgery in thyroid carcinoma patients.(2)We should be alert the symptoms occurring if the level of serum calcium is less than 1.81mmol/L. The symptoms will disappear within 7days after surgery if calcium is given in time.(3)The level of serum calcium seems no obvious relationship with the remains of parathyroid glands and the level of parathyroid gland hormones.