甲状腺/甲状旁腺术后早期低钙血症诱发的清醒状态下喉痉挛2例报道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

汤敏誉 ¹ ,  梁鹏 ^1,2

1. ;
2. ;

Corresponding author：

梁鹏, Email: liangpengwch@scu.edu.cn

Keywords：

喉痉挛; 低钙血症; 甲状腺切除术; 甲状旁腺切除术; 濒死感

DOI：

10.7507/1007-9424.202110045

Video：

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目的总结甲状腺/甲状旁腺术后早期低钙血症诱发的清醒状态下喉痉挛的原因及防治措施。方法对2例甲状腺/甲状旁腺术后早期低钙血症诱发喉痉挛患者的临床资料进行回顾性分析。结果 1例甲状腺右叶乳头状癌患者行甲状腺全切除 + 颈部右侧淋巴结清扫 + 右侧中央区淋巴结清扫，1例三发性甲状旁腺功能亢进症、左下甲状旁腺增生患者行颈部探查 + 左侧甲状旁腺全切除 + 术中喉返神经探查监测术。2例患者术后早期血清钙水平较术前迅速下降，患者清醒状态下出现喉痉挛。2例患者均予快速补充钙剂后，呼吸困难的临床症状迅速缓解。结论甲状腺/甲状旁腺切除术后可出现低钙血症，如血清钙水平迅速下降，甚至在清醒状态下诱发喉痉挛，及时纠正低钙血症后喉痉挛可迅速缓解，此类患者术后需要监测血清钙水平并预防性补钙。

Citation： 汤敏誉, 梁鹏. 甲状腺/甲状旁腺术后早期低钙血症诱发的清醒状态下喉痉挛2例报道. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 943-945. doi: 10.7507/1007-9424.202110045 Copy

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2.	Materazzi G, Ambrosini CE, Fregoli L, et al. Prevention and management of bleeding in thyroid surgery. Gland Surg, 2017, 6(5): 510-515.
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15.	Tsai WC, Peng YS, Chiu YL, et al. Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol, 2015, 47(7): 1203-1207.
16.	Kirkby-Bott J, Markogiannakis H, Skandarajah A, et al. Preoperative vitamin D deficiency predicts postoperative hypo calcemia after total thyroidectomy. World J Surg, 2011, 35(2): 324-330.
17.	Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab, 2020, 105(6): 1722-1736.
18.	Hou J, Shan H, Zhang Y, et al. Network meta-analysis of surgical treatment for secondary hyperparathyroidism. Am J Otolaryngol, 2020, 41(2): 102370. doi: 10.1016/j.amjoto.2019.102370.
19.	王玉霞, 于露, 曾庆萃, 等. 骨饥饿综合征导致低钙抽搐一例报道并文献复习. 中国全科医学, 2019, 22(23): 2889-2892.
20.	Wolak S, Scheunchen M, Holzer K, et al. Impact of preoperative Vitamin D3 administration on postoperative hypocalcaemia in patients undergoing total thyroidectomy (HypoCalViD): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 101. doi: 10.1186/s13063-016-1216-5.
21.	郝智. 甲状腺癌术后急性喉痉挛1例. 临床耳鼻咽喉头颈外科杂志, 2016, 30(6): 503-504.
22.	Arer IM, Kus M, Akkapulu N, et al. Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: a prospective randomized study. Int J Surg, 2017, 38: 9-14.
23.	Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(2): 142-146.
24.	Alhefdhi A, Mazeh H, Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist, 2013, 18(5): 533-542.

1. Buła G, Mucha R, Paliga M, et al. Postoperative acute respiratory failure in patients treated surgically for goiters. Pol Przegl Chir, 2015, 87(7): 331-335.
2. Materazzi G, Ambrosini CE, Fregoli L, et al. Prevention and management of bleeding in thyroid surgery. Gland Surg, 2017, 6(5): 510-515.
3. Pardal-Refoyo JL, Ochoa-Sangrador C. Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring. Systematic review and meta-analysis. Acta Otorrinolaringol Esp, 2016, 67(2): 66-74.
4. 孙辉, 刘晓莉, 张大奇, 等. 甲状腺手术中喉返神经保护及监测的临床应用. 中国普外基础与临床杂志, 2010, 17(8): 768-771.
5. Tang JA, Salapatas AM, Bonzelaar LB, et al. Parathyroidectomy for the treatment of hyperparathyroidism: thirty-day morbidity and mortality. Laryngoscope, 2018, 128(2): 528-533.
6. Witteveen JE, van Thiel S, Romijn JA, et al. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol, 2013, 168(3): R45-R53.
7. Mittendorf EA, Merlino JI, McHenry CR. Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management. Am Surg, 2004, 70(2): 114-119.
8. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ, 2008, 336(7656): 1298-1302.
9. Adler JT, Sippel RS, Schaefer S, et al. Preserving function and quality of life after thyroid and parathyroid surgery. Lancet Oncol, 2008, 9(11): 1069-1075.
10. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid, 2018, 28(7): 830-841.
11. Isk Y, Goktas U, Yuzkat N, et al. Hungry bone syndrome as a cause of recurrent laryngospasm after parathyroidectomy. Eur J Anaesthesiol, 2011, 28(2): 142-143.
12. Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol, 2018, 13(6): 952-961.
13. Shane E, Bilezikian JP. Parathyroid carcinoma: a review of 62 patients. Endocr Rev, 1982, 3(2): 218-226.
14. Ho LY, Wong PN, Sin HK, et al. Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol, 2017, 18(1): 12. doi: 10.1186/s12882-016-0421-5.
15. Tsai WC, Peng YS, Chiu YL, et al. Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol, 2015, 47(7): 1203-1207.
16. Kirkby-Bott J, Markogiannakis H, Skandarajah A, et al. Preoperative vitamin D deficiency predicts postoperative hypo calcemia after total thyroidectomy. World J Surg, 2011, 35(2): 324-330.
17. Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab, 2020, 105(6): 1722-1736.
18. Hou J, Shan H, Zhang Y, et al. Network meta-analysis of surgical treatment for secondary hyperparathyroidism. Am J Otolaryngol, 2020, 41(2): 102370. doi: 10.1016/j.amjoto.2019.102370.
19. 王玉霞, 于露, 曾庆萃, 等. 骨饥饿综合征导致低钙抽搐一例报道并文献复习. 中国全科医学, 2019, 22(23): 2889-2892.
20. Wolak S, Scheunchen M, Holzer K, et al. Impact of preoperative Vitamin D3 administration on postoperative hypocalcaemia in patients undergoing total thyroidectomy (HypoCalViD): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 101. doi: 10.1186/s13063-016-1216-5.
21. 郝智. 甲状腺癌术后急性喉痉挛1例. 临床耳鼻咽喉头颈外科杂志, 2016, 30(6): 503-504.
22. Arer IM, Kus M, Akkapulu N, et al. Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: a prospective randomized study. Int J Surg, 2017, 38: 9-14.
23. Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(2): 142-146.
24. Alhefdhi A, Mazeh H, Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist, 2013, 18(5): 533-542.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

甲状腺/甲状旁腺术后早期低钙血症诱发的清醒状态下喉痉挛2例报道

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