Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center.
State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center.
Int J Surg. 2024 Aug 1;110(8):5047-5062. doi: 10.1097/JS9.0000000000001475.
Postoperative hypoparathyroidism (hypoPT) is a common complication following thyroid surgery. However, current research findings on the risk factors for post-thyroid surgery hypoPT are not entirely consistent, and the same risk factors may have different impacts on transient and permanent hypoPT. Therefore, there is a need for a comprehensive study to summarize and explore the risk factors for both transient and permanent hypoPT after thyroid surgery.
Two databases (PubMed and Embase) were searched from inception to 2024. The Newcastle-Ottawa Scale was used to rate study quality. Pooled odds ratios were used to calculate the relationship of each risk factor with transient and permanent hypoPT. Subgroup analyses were conducted for hypoPT with different definition-time (6 or 12 months). Publication bias was assessed using Begg's test and Egger's test.
A total of 19 risk factors from the 93 studies were included in the analysis. Among them, sex and parathyroid autotransplantation were the most frequently reported risk factors. Meta-analysis demonstrated that sex (female vs. male), cN stage, central neck dissection, lateral neck dissection, extent of central neck dissection (bilateral vs. unilateral), surgery [total thyroidectomy (TT) vs. lobectomy], surgery type (TT vs. sub-TT), incidental parathyroidectomy, and pathology (cancer vs. benign) were significantly associated with transient and permanent hypoPT. Preoperative calcium and parathyroid autotransplantation were only identified as risk factors for transient hypoPT, while preoperative PTH was a protective factor. Additionally, node metastasis and parathyroid in specimen were associated with permanent hypoPT.
The highest risk of hypoPT occurs in female thyroid cancer patients with lymph node metastasis undergoing TT combined with neck dissection. The key to preventing postoperative hypoPT lies in the selection of surgical approach and intraoperative protection.
甲状腺手术后甲状旁腺功能减退（简称 hypoPT）是一种常见的并发症。然而，目前关于甲状腺手术后 hypoPT 的风险因素的研究结果并不完全一致，相同的风险因素对暂时性和永久性 hypoPT 的影响可能不同。因此，需要进行一项全面的研究来总结和探讨甲状腺手术后暂时性和永久性 hypoPT 的风险因素。
从建立到 2024 年，我们在两个数据库（PubMed 和 Embase）中进行了搜索。使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）对研究质量进行评分。使用合并优势比（pooled odds ratios）来计算每个风险因素与暂时性和永久性 hypoPT 的关系。对于不同定义时间（6 个月或 12 个月）的 hypoPT 进行亚组分析。使用 Begg 检验和 Egger 检验评估发表偏倚。
共有 93 项研究的 19 个风险因素纳入分析。其中，性别和甲状旁腺自体移植是最常报道的风险因素。Meta 分析表明，性别（女性与男性）、cN 分期、中央颈部清扫术、侧颈部清扫术、中央颈部清扫术范围（双侧与单侧）、手术方式[甲状腺全切除术（TT）与甲状腺叶切除术]、手术类型（TT 与次全 TT）、意外甲状旁腺切除术和病理（癌症与良性）与暂时性和永久性 hypoPT 显著相关。术前钙和甲状旁腺自体移植仅被确定为暂时性 hypoPT 的风险因素，而术前 PTH 是保护因素。此外，淋巴结转移和标本中的甲状旁腺与永久性 hypoPT 相关。
女性甲状腺癌伴淋巴结转移行 TT 联合颈部清扫术的患者 hypoPT 风险最高。预防术后 hypoPT 的关键在于选择手术方式和术中保护。
