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甲状腺手术中基于保留胸腺的甲状旁腺逆行保护技术的临床意义

Clinical significance of retrograde inferior parathyroid protection technique based on thymus preservation in thyroid surgery.

作者信息

Yan Shouyi, Chen Yuhan, Zhao Wenxin, Zhang Liyong, Cai Shaojun

机构信息

The Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, China.

Fujian Medical University, Fuzhou, Fujian Province, 350108, China.

出版信息

BMC Endocr Disord. 2025 Jan 26;25(1):23. doi: 10.1186/s12902-025-01838-y.

DOI:10.1186/s12902-025-01838-y
PMID:39865256
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11765936/
Abstract

BACKGROUND

The importance of parathyroid gland preservation in thyroid surgery has been well recognized; however, the rapid identification of the parathyroid gland, particularly the inferior parathyroid gland (IPG), remains challenging. This study aimed to evaluate the effectiveness of retrograde inferior parathyroid protection technique (RIPPT) based on thymus preservation.

METHODS

A total of 236 patients were enrolled in this study between August 2019 and December 2020. RIPPT was employed to identify and protect the inferior parathyroid gland (IPG), and its identification rate and the anatomical variations were analyzed. The parathyroid hormone (PTH) and serum calcium levels were compared between patients who underwent IPG orthotopic retention and those who received IPG auto-transplantation, stratified by the anatomical type of the IPG.

RESULTS

In total, the IPG identification rate was 97.88% (231/236), and the auto-transplantation rate was 74.46% (172/231). The anatomical relationship between IPG and thymus was observed in 77.97% of patients (184/236). Additionally, PTH levels were higher in patients with IPG orthotopic retention compared to those with IPG auto-transplantation both on postoperative day 1 (POD1) and at 6 months. PTH levels were also higher in patients with superior parathyroid gland (SPG) and IPG orthotopic retention compared to those who underwent both auto-transplantation procedures.

CONCLUSION

Retrograde inferior parathyroid protection technique (RIPPT) underscores the importance of protecting inferior parathyroid gland (IPG) in thyroid surgery and has been demonstrated to be effective in the rapid identification and functional preservation of IPG, based on short-term outcomes.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

甲状腺手术中甲状旁腺保留的重要性已得到充分认识；然而，快速识别甲状旁腺，尤其是下甲状旁腺（IPG），仍然具有挑战性。本研究旨在评估基于胸腺保留的逆行下甲状旁腺保护技术（RIPPT）的有效性。

方法

2019年8月至2020年12月期间，共有236例患者纳入本研究。采用RIPPT识别和保护下甲状旁腺（IPG），并分析其识别率和解剖变异。根据IPG的解剖类型，比较接受IPG原位保留的患者和接受IPG自体移植的患者的甲状旁腺激素（PTH）和血清钙水平。

结果

总体而言，IPG识别率为97.88%（231/236），自体移植率为74.46%（172/231）。77.97%的患者（184/236）观察到IPG与胸腺之间的解剖关系。此外，术后第1天（POD1）和6个月时，IPG原位保留的患者的PTH水平高于IPG自体移植的患者。上甲状旁腺（SPG）和IPG原位保留的患者的PTH水平也高于接受两种自体移植手术的患者。

结论

逆行下甲状旁腺保护技术（RIPPT）强调了在甲状腺手术中保护下甲状旁腺（IPG）的重要性，并且根据短期结果已证明该技术在快速识别和功能保留IPG方面是有效的。

临床试验编号

不适用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0927/11765936/1cc1711865c0/12902_2025_1838_Fig8_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0927/11765936/1cc1711865c0/12902_2025_1838_Fig8_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0927/11765936/05ac9ee6b0a3/12902_2025_1838_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0927/11765936/9efd8c3c4f0a/12902_2025_1838_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0927/11765936/a00342bf0771/12902_2025_1838_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0927/11765936/8fe2288d6335/12902_2025_1838_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0927/11765936/1cc1711865c0/12902_2025_1838_Fig8_HTML.jpg

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Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer.评估通过全乳晕入路内镜甲状腺切除术和预防性中央颈部清扫术治疗甲状腺癌中碳纳米颗粒的临床价值。
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