| Objective: To investigate the effect of parathyroid autotransplantation during endoscopic thyroidectomy on the recovery of postoperative parathyroid function and to identify risk factors for postoperative hypoparathyroidism.Methods: To retrospectively analyze the clinical data of patients with papillary thyroid papillary carcinoma admitted to the Department of General Surgery of Gansu Provincial People’s Hospital from January 2017 to January 2022 who underwent for endoscopic total thyroidectomy with or without central lymph node dissection.All intraoperative parathyroid glands preserved in situ were set as the preserved group(n=190),and one intraoperative graft was miscut or blood supply damaged,and the remaining parathyroid glands preserved in situ were set as the transplant group(n=210).Analyze the following information:⑴Baseline patient information and the occurrence of postoperative complications;⑵ The body circulating parathyroid hormone and Ca2+ concentrations at 1 day,1 week,1 month,3 months,6 months and 12 months after surgery were counted in both groups;⑶ The parathyroid hormone concentration in the elbow fossa vein of both arms(parathyroid hormone concentration at the graft site in the graft arm and parathyroid hormone concentration in the body circulation in the non-graft arm)was counted at the above follow-up time in the graft group,and graft survival was determined to be greater than 1.5 times the parathyroid hormone concentration in the elbow fossa vein of both arms,and the number of survivals was recorded;⑷ Incidence of transient hypoparathyroidism and permanent hypoparathyroidism at different follow-up times after surgery;⑸ Analysis of postoperative transient hypoparathyroidism and permanent hypoparathyroidism risk factors.Results: No statistical difference in baseline information between the two groups of patients(P>0.05).There was no statistical difference between the two groups in terms of body circulation parathyroid hormone before and 1 day after surgery(P>0.05),and the transplantation group was significantly higher than the preservation group from 1 week to 12 months after surgery(P<0.05),and the body circulation parathyroid hormone in the transplantation and preservation groups recovered to the preoperative level of 88.19% and 69.97%,respectively,at 12 months after surgery.When comparing the two groups of patients with body circulation Ca2+,the differences were not statistically significant(P>0.05)preoperatively,1 day postoperatively,and 1 week postoperatively,and the transplantation group was higher than the retention group from 1 month postoperatively to 12 months postoperatively(P<0.05).When comparing the adjacent follow-up period of body circulation parathyroid hormone in both groups of patients,it was significantly lower at 1 day postoperatively compared to preoperatively(P<0.05).The differences between the two adjacent follow-up periods from 1 day to 3 months postoperatively were statistically significant in the transplantation group(P<0.05),and the differences between the two adjacent follow-up periods from 3 months to 12 months postoperatively were not statistically significant(P>0.05).The differences between the two adjacent follow-up periods from 1 day postoperative to 6 months postoperative were statistically significant in the reserved group(P<0.05),and the differences between 6 months postoperative and 12 months postoperative were not statistically significant(P>0.05).There was no statistically significant difference between the parathyroid hormone concentrations in the elbow fossa head veins of both arms 1 day after surgery(P=0.177).parathyroid hormone concentrations in the head of the elbow fossa were significantly higher in the grafted arm than in the non-grafted arm from 1 week to 12 months postoperatively,and the difference was statistically significant(P<0.05).Graft survival and parathyroid hormone secretion was determined when the parathyroid hormone concentration ratio in the elbow fossa head veins of both arms was greater than 1.5 times,and statistical results showed that 10.95%(23/210),38.57%(81/210),84.76%(178/210),90.95%(191/210),93.33%(196/210),and 72.38%(152/210)of patients exhibited graft survival at 1 day,1 week,1 month,3 months,6 months,and 12 months postoperatively,in that order.210),93.33%(196/210),and 72.38%(152/210)patients demonstrated graft survival.Hypoparathyroidism occurred in 30.25%(121/400)of patients after surgery.Using 6 months postoperatively as the as of time,the total incidence of transient hypoparathyroidism was 26.25%(105/400)and PPT was 4.00%(16/400)in both groups;the incidence of TPT was 31.43%(66/210)and PPT was 1.90%(4/210)in the transplantation group;the incidence of transient hypoparathyroidism was 20.53%(39/190)and PPT was 6.32%(12/190)in the retention group)and permanent hypoparathyroidism incidence rate was 6.32%(12/190),with statistically significant differences(X2=9.971,P=0.007).Using 12 months after surgery as the as of time,the total incidence of transient hypoparathyroidism was 27.50%(110/400)occurred and the total incidence of permanent hypoparathyroidism was 2.75%(11/400)in both groups;the incidence of transient hypoparathyroidism was 32.38%(68/210)and the incidence of permanent hypoparathyroidism was 0.95%(2/210)in the transplantation group;the incidence of transient hypoparathyroidism was 22.11%(42/ The incidence of transient hypoparathyroidism was 22.11%(42/190)and the incidence of permanent hypoparathyroidism was 4.74%(9/190)in the retained group,with statistically significant differences(X2=9.628,P=0.008).There was no statistical difference in the incidence of permanent hypoparathyroidism diagnosed at 6 months and 12 months postoperatively as of the time of diagnosis,respectively(X2=1.042,P=0.594).Univariate logistic regression analysis showed that women(OR=1.981,95% CI 1.060-3.701,P=0.032),Graves’ disease(OR=1.712,95% CI 1.088-2.694,P=0.020),Hashimoto’s thyroiditis(OR=1.840,95% CI 1.156-2.928,P=0.010),parathyroid transplantation(OR=1.687,95% CI 1.078-2.642,P=022),and central lymph node dissection(OR=2.013,95% CI 1.289-3.141,P=0.002)as risk factors for transient hypoparathyroidism.Multifactorial logistic regression analysis showed that Hashimoto’s thyroiditis(OR=1.786,95% CI 1.096-2.911,P=0.020),parathyroid transplantation(OR=1.817,95% CI 1.129-2.924,P=0.014),central lymph node dissection(OR=1.949,95% CI 1.209-3.144,P=0.006)were transient hypoparathyroidism risk factors.Univariate logistic regression analysis showed that parathyroid transplantation(OR=0.193,95% CI 0.037-0.856,P=0.033)was a protective factor for permanent hypoparathyroidism and central lymph node dissection(OR=4.249,95% CI 1.110-16.268,P=0.035)was a risk factor for permanent hypoparathyroidism.Multifactorial logistic regression analysis showed that parathyroid transplantation(OR=0.139,95% CI 0.023-0.856,P=0.033)was a protective factor for permanent hypoparathyroidism and central lymph node dissection(OR=4.575,95% CI 1.039-20.153,P=0.004)was a risk factor for permanent hypoparathyroidism.Conclusion: Selective parathyroid autotransplantation increases the incidence of transient hypoparathyroidism,but has an important role in preventing permanent hypoparathyroidism.On the basis of preserving parathyroid glands in situ as much as possible during endoscopic thyroidectomy,selective transplantation of intraoperatively damaged or poorly supplied parathyroid glands is more conducive to recovery of postoperative parathyroid function.To reduce the incidence of hypoparathyroidism after endoscopic thyroidectomy,patients with Graves’ disease and Hashimoto’s thyroiditis should be closely monitored and thyroid function corrected preoperatively to reduce the blood supply to the thyroid gland.Preoperatively,we combined neck ultrasound,CT and fine needle aspiration biopsy of the thyroid gland to assess the metastasis of lymph nodes in the neck and perform central lymph node dissection cautiously;postoperatively,we formulated different calcium supplementation regimens according to patients’ ion indexes. |
PDF Full Text Request