Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, China.
Department of Anesthesiology, Gansu Provincial People's Hospital, Lanzhou, China.
Front Endocrinol (Lausanne). 2023 Jun 27;14:1193851. doi: 10.3389/fendo.2023.1193851. eCollection 2023.
To evaluate the safety and efficacy of autologous parathyroid transplantation in laparoscopic total thyroidectomy combined with central lymph node dissection (CLND).
Retrospective analysis of clinical data of 152 patients admitted to the General Surgery Department of Gansu Provincial People's Hospital who underwent endoscopic total thyroidectomy combined with CLND from June 2018 to December 2021. The intraoperative parathyroid glands were divided into the orthotopic preservation group (non-transplantation group) and the immediate active autologous transplantation group (transplantation group) according to the different treatment management of parathyroid glands during operation. The levels of Ca2+ in parathyroid blood and the incidence of hypoparathyroidism were compared between the two groups before operation and 1 day, 3 day, 1 week, 1 month, 3 months and 6 months after operation.
There was no significant difference in PTH between the preoperative transplantation group compared and the non-transplantation group (P>0.05); The PTH in the transplantation group was lower than that of the non-transplantation group 1 and 3 d after surgery, and the difference was statistically significant (P<0.05); No statistically significant difference in PTH between patients in the transplantation group compared with those in the non-transplantation group at 1 week postoperatively (P>0.05); PTH was significantly higher in the transplant group than in the non-transplant group at 1, 3 and 6 months after surgery, with statistically significant differences (P<0.05); there was no statistically differences (P>0.05) in serum Ca between the preoperative, 1d, 3d and 1 week postoperative transplantation group and the non-transplantation group; Blood Ca was significantly higher in the transplant group than in the non-transplant group at 1, 3 and 6 months after surgery, with statistically significant differences (P<0.05); The rate of temporary hypoparathyroidism in the transplantion group was higher than that in the non-transplantion group, and the rate of permanent hypoparathyroidism was lower than that in the non-transplantion group (P=0.044); There was no significant difference in the concentration of PTH in the cephalic vein of the elbow between the transplanted side and the non-transplanted side at 1 day and 3 days postoperatively (P>0.05); the concentration of PTH in cephalic vein of the elbow was significantly higher than that in non-transplanted side at 1 week, 1 month, 3 months and 6 months postoperatively (P<0.001); the number central area dissection and metastasis dissection in the transplantation group were significantly higher than those in the non-transplantation group (P<0.05).
Most autologous parathyroid glands, having functional parathyroid autograft, is helpful to the occurrence of hypoparathyroidism after endoscopic total thyroidectomy with CLND, and it is an effective strategy to prevent permanent hypoparathyroidism, and more thorough area dissection is beneficial to the disease prognosis.
评估腹腔镜甲状腺全切除术联合中央淋巴结清扫术（CLND）中自体甲状旁腺移植的安全性和有效性。
回顾性分析 2018 年 6 月至 2021 年 12 月甘肃省人民医院普外科收治的 152 例行内镜甲状腺全切除术联合 CLND 的患者的临床资料。根据术中甲状旁腺的不同处理方式，将甲状旁腺分为原位保留组（非移植组）和即刻主动自体移植组（移植组）。比较两组患者术前及术后 1、3、1 周、1 个月、3 个月、6 个月甲状旁腺血 Ca2+水平及甲状旁腺功能减退症的发生率。
移植组与非移植组患者术前 PTH 比较差异无统计学意义（P>0.05）；移植组患者术后 1、3 d 时 PTH 低于非移植组，差异有统计学意义（P<0.05）；术后 1 周时移植组患者 PTH 与非移植组比较差异无统计学意义（P>0.05）；术后 1、3、6 个月时移植组患者 PTH 明显高于非移植组，差异有统计学意义（P<0.05）；术前、术后 1d、3d、1 周时移植组与非移植组患者血清 Ca 比较差异无统计学意义（P>0.05）；术后 1、3、6 个月时移植组患者血 Ca 明显高于非移植组，差异有统计学意义（P<0.05）；移植组暂时性甲状旁腺功能减退症发生率高于非移植组，永久性甲状旁腺功能减退症发生率低于非移植组（P=0.044）；术后 1 天和 3 天，移植侧和非移植侧肘静脉甲状旁腺素（PTH）浓度差异无统计学意义（P>0.05）；术后 1 周、1 个月、3 个月、6 个月，移植侧肘静脉 PTH 浓度明显高于非移植侧（P<0.001）；移植组中央区清扫和转移区清扫数量明显多于非移植组（P<0.05）。
大多数自体甲状旁腺移植后甲状旁腺功能具有自主功能，有助于预防内镜甲状腺全切除术联合 CLND 后甲状旁腺功能减退症的发生，是预防永久性甲状旁腺功能减退症的有效策略，更彻底的区域清扫有利于疾病预后。
