Objective To explore risk factors of hypocalcemia after thyroidectomy in general hospital. Method We collected clinical data of patients with thyroid diseases prospectively between January 2014 and September 2016. The clinical characteristics, laboratory markers, surgical details and postoperative pathologic results of normocalcemic and hypocalcemic patients were compared. Result Transient hypocalcemia were found in 35 (9%) out of 385 patients. Most patients with transient hypocalcemia or inadvertent parathyroidectomy (IPE) had no significant clinical manifestation. The percentage of hypocalmia caused by IPE was lower than disturbance of parathyroid or it's blood supply. The serum calcemia was lower in patients with malignant tumor, bilateral diseases, disturbance of bilateral capsule behind thyroid, longer operative time, central neck dissection or IPE. The odds ratio of "disturbance of bilateral capsule behind thyroid" and "IPE" were 16.1 and 4.16 respectively (P<0.05) according to multivariate logistic regression. Conclusion The major reason of hypocalcemia after thyroidectomy was disturbance of parathyroid or it's blood supply. IPE and disturbance of bilateral capsule behind thyroid were recognized as independent risk factors, and we recommend meticulous capsular dissection technique during surgery to keep parathyroid glands in situ.%目的 探讨甲状腺术后低钙血症的危险因素.方法 前瞻性收集2014年1月至2016年9月在本院行甲状腺手术患者的临床资料,比较术后低钙血症组及血钙正常组的一般资料、实验室检查结果、手术相关指标及病理检查情况.结果 共纳入385例患者,其中35例(9%)出现暂时性低钙血症.多数暂时性低钙血症患者及甲状旁腺误切患者无明显低钙相关临床表现.甲状旁腺误切所致低钙血症的比例明显少于血供或腺体本身破坏所占比例.恶性肿瘤、双侧病变、双侧甲状腺后被膜破坏、手术时间长、清扫中央组淋巴结、甲状旁腺误切者更容易出现术后低钙血症;多因素Logistic回归分析提示甲状腺后被膜破坏及甲状旁腺误切是术后发生低钙血症的独立危险因素(OR=16.1,OR=4.16,P<0.01).结论 甲状腺术后低钙血症的主要原因是甲状旁腺血供障碍或其本身破坏.双侧甲状腺后被膜破坏及甲状旁腺误切是甲状腺术后低钙血症的独立危险因素,建议术中采用被膜精细解剖法,原位保留甲状旁腺.
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