Xing Zhichao, Qiu Yuxuan, Xia Baoying, Abuduwaili Munire, Fei Yuan, Zhu Jingqiang, Su Anping
Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
Gland Surg. 2021 Jan;10(1):10-22. doi: 10.21037/gs-20-486.
Parathyroid glands protection is still controversial in patients with less than 4 parathyroid glands during thyroidectomy. The aim of this study was to investigate the strategy of parathyroid autotransplantation or preservation in patients with 3 parathyroid glands.
Consecutive patients who underwent primary total thyroidectomy with bilateral central neck dissection for papillary thyroid carcinoma (PTC) in our center were included retrospectively. Serum calcium and parathyroid hormone (PTH) levels (pg/mL), incidence of hypocalcemia and hypoparathyroidism during 24 months follow-up were compared grouping by the number of parathyroid glands both identified intraoperatively and confirmed postoperatively by pathology.
A total of 1,424 patients were included. Serum PTH and calcium levels were lower and the incidence of hypocalcemia was higher in patients with 3 identified parathyroid glands. When excluding patients with accidental parathyroid resection, the results remained similar. Of the 212 patients with 3 identified parathyroid glands, PTH levels at postoperative 12-month in patients underwent autotransplantation were significantly lower than patients with all parathyroid glands preserved (3.65±1.30 4.67±1.89, P=0.026).
The parathyroid function was weaker in patients with 3 parathyroid glands than patients with 4 before and after operation. Parathyroid glands preserved all promoted better recovery of postoperative function in patients with 3 identified parathyroid glands.
在甲状腺切除术中甲状旁腺少于4个的患者中，甲状旁腺的保护仍存在争议。本研究的目的是探讨在有3个甲状旁腺的患者中行甲状旁腺自体移植或保留的策略。
回顾性纳入在本中心因乳头状甲状腺癌（PTC）接受初次全甲状腺切除并双侧中央区颈淋巴结清扫的连续患者。根据术中识别并经术后病理证实的甲状旁腺数量进行分组，比较24个月随访期间的血清钙和甲状旁腺激素（PTH）水平（pg/mL）、低钙血症和甲状旁腺功能减退的发生率。
共纳入1424例患者。识别出3个甲状旁腺的患者血清PTH和钙水平较低，低钙血症发生率较高。排除意外甲状旁腺切除的患者后，结果仍相似。在212例识别出3个甲状旁腺的患者中，接受自体移植的患者术后12个月时的PTH水平显著低于甲状旁腺全部保留的患者（3.65±1.30对4.67±1.89，P = 0.026）。
有3个甲状旁腺的患者术前术后甲状旁腺功能均弱于有4个甲状旁腺的患者。对于识别出3个甲状旁腺的患者，全部保留甲状旁腺可促进术后功能更好地恢复。
