Melo Catarina, Bernardes António, Cardoso Luis, Miguéis António
Department of Anatomy, Faculty of Medicine, University of Coimbra, Coimbra Hospital and University Centre, Coimbra, Portugal.
National Institute of Legal Medicine and Forensic Sciences, Coimbra, Portugal.
Surg Radiol Anat. 2025 Sep 19;47(1):207. doi: 10.1007/s00276-025-03720-x.
The aim of this work was to study the vascularization of parathyroid glands (PTG) and determine the features that may influence its preservation. Based on those findings we propose surgical strategies to preserve the parathyroid vascular supply in thyroid surgery.
A study of the vascular supply of 110 PTG was performed in 30 cadaver specimens. The thyroid arteries were cannulated and injected with an isoprene polymer. Data collection included: number and location of PTG and information about their vascular supply: origin, number of arteries, length, course, relation with recurrent laryngeal nerve (RLN) and thyroid lobe. There were determined the most variable features and the most consistent features about PTG arteries.
The vascular supply of PTG was provided by a terminal artery. The PTG's hilum was related to the thyroid surface. The PTG received 1 vessel in most cases, with no significant difference between the superior and inferior PTG (P = 0.111). The superior PTG received a vessel from the posterior branch of inferior thyroid artery (ITA) in 49 cases (87.5%) and the inferior PTG received a vessel from the anterior branch of ITA in all 54 cases (100%). The length of the arteries was on average 7 mm and the arteries to inferior PTG were smaller (P = 0.004). The artery to superior PTG described a cranial course in 40 cases (71.4%) and the artery to the inferior PTG described a caudal course in 31 cases (57.4%) (P < 0.001). The parathyroid arteries were located anterior to the RLN in most cases. The arteries to superior PTG were all posterior to the thyroid lobe and the arteries for inferior PTG were posterior to the thyroid lobe in 48 cases (88.9%) and course through the thyroid parenchyma in 6 cases (11,1%). All PTG arteries were located lateral to the attachment of the pretracheal layer of the deep cervical fascia to the trachea.
The origin, number, course and length of the parathyroid arteries are variable, which influence its preservation. There are some consistent features that can guide thyroidectomy. The PTG should be retracted from medial-to-lateral direction from the thyroid surface to protect their hilum. The PTG located anterior to the thyroid lobe may need to be re-implanted, once their artery crosses thyroid parenchyma. The area posterior to the thyroid lobe, anterior to the recurrent laryngeal nerve and lateral to the pretracheal layer of the deep cervical fascia should be spared from dissection and vessel ligation, once is the main territory for PTG arteries.
本研究旨在探讨甲状旁腺（PTG）的血管分布，并确定可能影响其保留的特征。基于这些发现，我们提出了在甲状腺手术中保留甲状旁腺血管供应的手术策略。
对30例尸体标本中的110个PTG的血管供应进行了研究。将甲状腺动脉插管并注入异戊二烯聚合物。数据收集包括：PTG的数量和位置以及其血管供应的信息：起源、动脉数量、长度、走行、与喉返神经（RLN）和甲状腺叶的关系。确定了PTG动脉最具变异性和最一致的特征。
PTG的血管供应由终末动脉提供。PTG的门与甲状腺表面相关。大多数情况下，PTG接受1条血管，上、下PTG之间无显著差异（P = 0.111）。49例（87.5%）上PTG从甲状腺下动脉（ITA）后支接受1条血管，54例下PTG均（100%）从ITA前支接受1条血管。动脉平均长度为7mm，下PTG的动脉较细（P = 0.004）。40例（71.4%）上PTG的动脉走行向上，31例（57.4%）下PTG的动脉走行向下（P < 0.001）。大多数情况下，甲状旁腺动脉位于RLN前方。上PTG的动脉均位于甲状腺叶后方，下PTG的动脉48例（88.9%）位于甲状腺叶后方，6例（11.1%）穿过甲状腺实质。所有PTG动脉均位于颈深筋膜气管前层附着于气管外侧。
甲状旁腺动脉的起源、数量、走行和长度存在变异，这会影响其保留。有一些一致的特征可指导甲状腺切除术。应从甲状腺表面由内侧向外侧牵拉PTG以保护其门。一旦其动脉穿过甲状腺实质，位于甲状腺叶前方的PTG可能需要重新植入。甲状腺叶后方、喉返神经前方和颈深筋膜气管前层外侧的区域应避免解剖和血管结扎，因为这是PTG动脉的主要分布区域。
