Journal of Shandong University (Health Sciences) ›› 2020, Vol. 58 ›› Issue (9): 14-20.doi: 10.6040/j.issn.1671-7554.0.2020.090

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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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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

CLC Number: 

  • R574
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