갑상선 전절제술 후 저칼슘혈증 = 빈도 및 위험인자

다국어 초록 (Multilingual Abstract)

Purpose: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and risk factors for postoperative hypocalcemia after total thyroidectomy.
Methods: There were 196 consecutive patients undergoing total thyroidectomy for thyroid cancer between September 2004 and February 2005 who were enrolled in this study. Patients were divided into two groups, those remaining normocalcemic (Group Ⅰ) and those who had hypocalcemia requiring treatment (Group Ⅱ). Group Ⅱ was subdivided into a transient hypocalcemic group (Group ⅡA) and a permanent hypocalcemic group (Group ⅡB). All groups were compared with regard to age, gender, histology, coexisting disease, T stage, bilateral lesions, primary total thyroidectomy versus secondary completion thyroidectomy, extent of lymph node dissection, and autotransplantation of the parathyroid gland.
Results: Among all patients, 139 (71%) were in Group I, 54 (27.5%) in Group ⅡA and 3 (1.5%) in Group ⅡB. On the multivariate analysis for risk factors compared between Group Ⅰ and Group Ⅱ, the T4 stage was the most significant for the development of postoperative hypocalcemia. On the univariate analysis comparing factors between Group ⅡA and Group ⅡB, the T4 stage and a complete thyroidectomy were significantly related to the development of permanent hypocalcemia.
Conclusion: The results of this study showed that the incidence of transient hypocalcemia, after total thyroidectomy, was 27.5%, while permanent hypocalcemia was detected in 1.5% of cases. The parathyroid glands should be preserved more carefully to avoid postoperative hypocalcemia in patients with high risk factors including T4 tumors and complete thyroidectomy procedures.

목차 (Table of Contents)

• 서론
• 방법
• 결과
• 고찰
• 결론
• REFERENCES

참고문헌 (Reference)

1 정소영, "갑상선절제술 후 혈종의 임상 양상" 대한외과학회 67 (67): 286-289, 2004

2 Bourrel C, "Transient hypocalcemia after thyroidectomy" 102 : 496-501, 1993

3 Harness JK, "Total thyroidectomy: complications and technique" 10 : 781-786, 1986

4 Schwartz AE, "Therapeutic controversy: thyroid surgery-the choice" 83 : 1097-1105, 1998

5 Filho JG, "Surgical complications after thyroid surgery performed in a cancer hospital" 132 : 490-494, 2005

6 Reeve TS, "Secondary thyroidectomy: a twenty-year experience" 12 : 449-453, 1988

7 Shindo LM, "Safety of thyroidectomy in residency: a review of 186 consecutive cases" 105 : 1173-1175, 1995

8 Burge MR, "Risks of complication following thyroidectomy" 13 : 24-31, 1998

9 Abboud B, "Risk factors for postthyroidectomy hypocalcemia" 195 : 456-461, 2002

10 Kowalski LP, "Results of the treatment of locally invasive thyroid carcinoma" 24 : 340-344, 2002

11 Wingert DJ, "Post-thyroidectomy hypocalcemia" 152 : 606-609, 1986

12 Pezzullo L, "Post- operative complications after completion thyroidectomy for differentiated thyroid cancer" 23 : 215-218, 1997

13 Olson JA, "Parathyroid autotransplantation during thyroidectomy. Results of long- term follow-up" 223 : 472-478, 1996

14 Lo CY, "Parathyroid autotransplantation during thyroidectomy" 72 : 902-907, 2002

15 Pederson WC, "Operative management of thyroid disease" 148 : 350-352, 1984

16 Bergamaschi R, "Morbidity of thyroid surgery" 176 : 71-75, 1998

17 Michie W, "Mechanisms of hypocalcemia after thyroidectomy for thyrotoxicosis" 1 : 508-514, 1971

18 Flynn MB, "Local complications after surgical resection for thyroid carcinoma" 168 : 404-407, 1994

19 Watkins E Jr, "Incidence and current management of post-thyroidectomy hypoparathyroidism. Histologic evidence of rejection of neonatal aortic pedicle parathyroid gland homotransplants" 182 : 140-146, 1962

20 Pattou F, "Hypocalcemia following thyroid surgery: incidence and prediction of outcome" 22 : 718-724, 1998

21 Prim MP, "Factor related to nerve injury and hypocalcemia in thyroid gland surgery" 124 : 111-114, 2001

22 Al-Suliman NN, "Experience in a specialist thyroid surgery unit: a demographic study, surgical complications, and outcome" 163 : 13-20, 1997

23 Thompson NW, "Continuing development of the technique of thyroidectomy" 73 : 913-927, 1973

24 Moulton-Barrett R, "Complications of thyroid surgery" 82 : 63-66, 1997

25 Bearhrs OH, "Complications of secondary thyroidectomy" 117 : 535-539, 1963

26 Cheah WK, "Complications of neck dissection for thyroid cancer" 26 : 1013-1016, 2002

27 Herranz-Gonzalez J, "Complications following thyroid surgery" 117 : 516-518, 1991

28 Shaha A, "Compications of thyroid surgery performed by residents" 104 : 1109-1114, 1988

29 Erdem E, "Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma" 29 : 747-749, 2003

30 Singh B, "Coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome" 126 : 1070-1077, 1999