Sun Haili, Gao Li, Xiao Guizhou, Xie Lei, Zhuang Yiyu, Wang Jianbiao
Nursing Department, The Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Head and Neck Surgery, The Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Front Surg. 2025 Apr 24;12:1565581. doi: 10.3389/fsurg.2025.1565581. eCollection 2025.
The impact of parathyroid gland autotransplantation on permanent hypoparathyroidism remains incompletely understood. This study aimed to ascertain how selective autotransplantation of parathyroid glands affects the occurrence of permanent hypoparathyroidism after total thyroidectomy with central neck dissection (CND).
A retrospective cohort study encompassed consecutive patients with papillary thyroid carcinoma who underwent primary total thyroidectomy plus CND from January 2008 to December 2010 and January 2012 to December 2019. Patients were categorized into two groups (0 and ≥1 parathyroid glands autotransplanted, respectively).
The autotransplantation group comprised 501 patients, while the non-autotransplantation group comprised 652 patients. The autotransplantation group showed significantly lower permanent hypoparathyroidism than the non-autotransplantation group [1.2% (6 of 501) vs. 4.4% (29 of 652), = 0.001]. Out of the total 1,153 patients, 652 (56.5%) had no autotransplanted glands, and 358 (31.0%), 136 (11.8%), and 7 (0.6%) had 1, 2, and 3 glands autotransplanted, respectively. As the number of autotransplanted glands increased (from 0 to 3), the prevalence of permanent hypoparathyroidism was 4.4% (29 of 652), 1.4% (5 of 358), 0.7% (1 of 136), and 0.0% (0 of 7), respectively ( = 0.016). Multivariate logistic analysis revealed that parathyroid autotransplantation independently prevented postoperative permanent hypoparathyroidism.
Selective parathyroid autotransplantation is associated with a lower risk of permanent postoperative hypoparathyroidism. Autotransplantation is recommended for parathyroid glands that are devascularized or challenging to preserve in their original location.
甲状旁腺自体移植对永久性甲状旁腺功能减退的影响尚未完全明确。本研究旨在确定甲状旁腺选择性自体移植如何影响全甲状腺切除联合中央区淋巴结清扫术（CND）后永久性甲状旁腺功能减退的发生情况。
一项回顾性队列研究纳入了2008年1月至2010年12月以及2012年1月至2019年12月期间连续接受初次全甲状腺切除加CND的乳头状甲状腺癌患者。患者被分为两组（分别为未进行甲状旁腺自体移植和进行≥1个甲状旁腺自体移植）。
自体移植组有501例患者，非自体移植组有652例患者。自体移植组永久性甲状旁腺功能减退的发生率显著低于非自体移植组[1.2%（501例中的6例）对4.4%（652例中的29例），P = 0.001]。在总共1153例患者中，652例（56.5%）未进行甲状旁腺自体移植，358例（31.0%）、136例（11.8%）和7例（0.6%）分别进行了1个、2个和3个甲状旁腺的自体移植。随着自体移植甲状旁腺数量的增加（从0个到3个），永久性甲状旁腺功能减退的患病率分别为4.4%（652例中的29例）、1.4%（358例中的5例）、0.7%（136例中的1例）和0.0%（7例中的0例）（P = 0.016）。多因素逻辑回归分析显示，甲状旁腺自体移植可独立预防术后永久性甲状旁腺功能减退。
甲状旁腺选择性自体移植与术后永久性甲状旁腺功能减退风险较低相关。对于血运受损或难以原位保留的甲状旁腺，建议进行自体移植。
