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山东大学学报 (医学版) ›› 2020, Vol. 58 ›› Issue (9): 14-20.doi: 10.6040/j.issn.1671-7554.0.2020.090

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303例甲状旁腺切除术围术期观察及术后严重低钙血症危险因素分析

张洪彬1,2,赵寒辉2,王素霞2,周鹏3,贺青卿3,王延群4,丁伟平5,柳刚1   

  1. 1. 山东大学第二医院肾内科, 山东大学肾脏病研究所, 山东 济南 250033;2. 中国人民解放军联勤保障部队第九六〇医院血液净化科, 山东 济南 250031;3. 中国人民解放军联勤保障部队第九六〇医院甲状腺乳腺外科, 山东 济南 250031;4. 中国人民解放军联勤保障部队第九六〇医院检验科, 山东 济南 250031;5. 中国人民解放军联勤保障部队第九六〇医院核医学科, 山东 济南 250031
  • 出版日期:2020-09-10 发布日期:2020-08-30
  • 通讯作者: 柳刚. E-mail:lg69007@163.com
  • 基金资助:
    山东省重点研发计划(2017GSF18113)

Perioperative observation and postoperative risk factors of severe hypocalcemia after parathyroidectomy: a report of 303 cases

ZHANG Hongbin1,2, ZHAO Hanhui2, WANG Suxia2, ZHOU Peng3, HE Qingqing3, WANG Yanqun4, DING Weiping5, LIU Gang1   

  1. 1. Department of Nephrology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Nephrology Research Institute of Shandong University, Jinan 250033, Shandong, China;
    2. Department of Blood Purification, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan 250031, Shandong, China;
    3. Department of Thyroid and Breast, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan 250031, Shandong, China;
    4. Department of Laboratory, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan 250031, Shandong, China;
    5. Department of Nuclear Medicine, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan 250031, Shandong, China
  • Online:2020-09-10 Published:2020-08-30

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摘要： 目的 探讨甲状旁腺切除术(PTX)治疗难治性继发性甲状旁腺功能亢进(SHPT)围手术期安全性、有效性及发生术后严重低钙血症危险因素。 方法 选取2010年11月至2018年12月在中国人民解放军第九六〇医院行PTX的难治性SHPT患者303例。收集患者术前、术后血全段甲状旁腺素(iPTH),血清钙、磷、碱性磷酸酶等指标,进行统计学分析,观察术后并发症及预后。对严重低钙血症患者行单因素、多因素分析,确定术后发生严重低钙血症危险因素。 结果 303例共切除甲状旁腺1 216枚。手术治愈率及成功率均为99%,284例手术当天骨痛及瘙痒缓解,19例1周左右缓解。术后第1天iPTH ［25.65(16.00,43.20)pg/mL］、血清磷［1.43(1.01,1.94)mmol/L］、血清钙［2.04(1.76,2.29)mmol/L］均较术前下降,差异有统计学意义(P<0.001)。术后出现低钙血症171例(56.44%),严重低钙血症106例(34.98%),皮下出血及血肿10例(3.3%),低血压休克2例(0.6%),皮下气肿1例(0.3%),急性脑梗死1例(0.3%),均经对症处理后恢复。单因素分析显示,年龄及术前血钙、碱性磷酸酶、iPTH差异有统计学意义(P<0.05);多因素分析显示,年龄、术前血钙、术前iPTH为术后严重低钙血症独立危险因素。 结论 PTX对尿毒症难治性SHPT是一种安全有效的治疗手段,术前血钙偏低、年龄较小、iPTH较高的患者术后容易发生严重低钙血症。

关键词: 继发性甲状旁腺功能亢进, 甲状旁腺切除术, 严重低钙血症

Abstract: Objective To investigate the perioperative safety and efficacy of parathyroidectomy(PTX)in the treatment of refractory secondary hyperparathyroidism(SHPT)and risk factors of postoperative severe hypocalcemia. Methods Atotal of 303 patients with refractory SHPT who underwent PTX in the 960th Hospital of the PLA Joint Logistics Support Force during Nov. 2010 and Dec. 2018 were involved. The preoperative and postoperative blood parathyroid hormone(iPTH), serum calcium, phosphorus and alkaline phosphatase were collected and statistically analyzed, and the postoperative complications and prognosis were observed. Univariate and multivariate analyses were performed for patients with severe hypocalcemia to determine the risk factors. Results A total of 1 216 parathyroid glands were resected in the 303 cases. The cure rate and success rate were both 99%. Symptoms of bone pain and itching were relieved in 284 cases on the day of operation, and in 19 cases 1 week after operation. On day-1 after operation, iPTH ［25.65(16.00, 43.20)pg/mL］, serum phosphorus ［1.43(1.01, 1.94)mmol/L］ and serum calcium ［2.04(1.76, 2.29)mmol/L］ were significantly lower than those before operation(P<0.001). Hypocalcemia occurred in 171 cases(56.44%)after operation, severe hypocalcemia in 106 cases(34.98%), subcutaneous hemorrhage and hematoma in 10 cases(3.3%), hypotension shock in 2 cases(0.6%), subcutaneous emphysema in 1 case(0.3%), and acute cerebral infarction in 1 case(0.3%). All patients recovered after symptomatic treatment. Univariate analysis showed that age, preoperative serum calcium, alkaline phosphatase and iPTH were significantly different(P<0.05). Multivariate analysis showed that age, preoperative serum calcium and iPTH were independent risk factors of severe hypocalcemia. Conclusion PTX is a safe and effective treatment for uremic refractory SHPT. Patients with low preoperative serum calcium, young age and high iPTH are prone to develop severe hypocalcemia after operation.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Severe hypocalcemia

中图分类号: 

  • R574
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