自体甲状旁腺移植在全甲状腺切除术中和术后功能恢复中的有效性：回顾性研究

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-04-01 DOI:10.1016/j.ejso.2025.110007

Guannan Ge , Ying Lu , Hua Huang , Zifeng Kuang , Hao Zhao , Yue Cao , Yu Xia , Xiaoyi Li

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引用次数: 0

摘要

甲状腺癌是最常见的内分泌恶性肿瘤，甲状腺全切除术是一种标准治疗方法。然而，这种手术有甲状旁腺功能减退的风险。自体甲状旁腺移植（PAT）被推荐用于预防术后甲状旁腺功能低下，尽管其有效性和甲状旁腺功能的恢复尚不清楚。方法回顾性分析2012年4月至2024年2月在北京协和医院行四腺体甲状腺全切除术的患者。排除标准为术后48 h内未补充血钙≤2.11 mmol/L及随访不充分。分析术前、术后多个时间点血清钙、甲状旁腺激素（PTH）水平，评价甲状旁腺功能恢复情况及PAT的有效性。根据甲状旁腺移植时间将患者分为立即移植组和非立即移植组。比较各组各时间点血钙水平。结果本研究纳入142例患者。与术前比较，术后24 h、48 h、1周血清钙、甲状旁腺激素水平均显著降低。术后1个月血清钙、甲状旁腺素水平与术前比较无明显差异。与非立即移植组相比，立即移植组在第一个月内的血清钙水平较高，但在随后的时间点上没有观察到显著差异。永久性甲状旁腺功能低下发生率为1.4%（2/142）。结论pat能有效恢复和维持甲状腺全切除术后甲状旁腺功能。功能恢复开始于pat后1周，1个月内完成，此后功能稳定。尽量减少体外甲状旁腺操作并立即进行PAT可促进甲状旁腺功能的早期恢复。

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Effectiveness of parathyroid autotransplantation during total thyroidectomy and functional recovery post-operation: A retrospective study

Introduction

Thyroid carcinoma is the most common endocrine malignancy, with total thyroidectomy being a standard treatment. However, this procedure carries a risk of hypoparathyroidism. Parathyroid autotransplantation (PAT) is recommended to prevent postoperative hypoparathyroidism, though its effectiveness and the recovery of parathyroid function remain poorly understood.

Methods

A retrospective study was conducted on patients who underwent total thyroidectomy with four-gland PAT at Peking Union Medical College Hospital between April 2012 and February 2024. Exclusion criteria included postoperative serum calcium levels >2.11 mmol/L without supplementation within 48 h and inadequate follow-up. Preoperative and postoperative serum calcium and parathyroid hormone (PTH) levels were analysed at multiple time points to assess parathyroid function recovery and the effectiveness of PAT. Patients were divided into an immediate transplantation group and a non-immediate transplantation group based on the timing of parathyroid gland transplantation. Serum calcium levels were compared between the groups at various time points.

Results

This study included 142 patients. Compared with preoperative levels, the mean of serum calcium and PTH levels significantly decreased at 24 h, 48 h and 1week postoperatively. From 1 month post-surgery serum calcium and PTH levels showed no significant difference compared with preoperative levels. The immediate transplantation group had higher serum calcium levels within the first month compared to the non-immediate group, but no significant difference was observed at later time points. Permanent hypoparathyroidism occurred in 1.4 % (2/142) of patients.

Conclusion

PAT is effectively restores and maintains parathyroid function following total thyroidectomy. Functional recovery begins 1 week post-PAT and is complete in 1 month with stable function thereafter. Minimising in vitro parathyroid gland manipulation and performing PAT immediately can enhance early recovery of parathyroid function.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.