Abstract：
BACKGROUND: There is ongoing debate about whether intraoperative parathyroid autotransplantation effectively prevents permanent hypoparathyroidism after thyroidectomy. This study aims to examine its impact on postoperative parathyroid function and determine the best autotransplantation strategy.
METHODS: A retrospective analysis was conducted on 194 patients who underwent total thyroidectomy with central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC). Patients were divided into four groups based on the number of parathyroid autotransplants during surgery: Group 1 (none, n = 43), Group 2 (1 transplant, n = 60), Group 3 (2 transplants, n = 67), and Group 4 (3 transplants, n = 24). Various clinical parameters were collected and compared among the groups.
RESULTS: Parathyroid autotransplantation was identified as a risk factor for temporary hypoparathyroidism (OR: 1.74; 95% CI: 1.27-2.39, P = 0.001) and a protective factor for permanent hypoparathyroidism (OR: 0.27; 95% CI: 0.14-0.55, P < 0.001). At 12 months postoperative, systemic parathyroid hormone (PTH) levels increased progressively from Groups 1 to 4, with significant differences observed only between Group 1 and Group 2 (P < 0.02). Difference values in systemic PTH levels between Month 1 and Day 1 postoperative increased progressively from Groups 1 to 4, with statistically significant differences observed between adjacent groups (P < 0.02). The number of dissected positive lymph nodes increased progressively across the four groups, showing statistical differences (P < 0.02).
CONCLUSIONS: Parathyroid autotransplantation can prevent permanent hypoparathyroidism. Additionally, we recommend preserving parathyroids in situ whenever possible. If autotransplantation is required, it should involve no more than two glands.
METHODS: A retrospective analysis was conducted on 194 patients who underwent total thyroidectomy with central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC). Patients were divided into four groups based on the number of parathyroid autotransplants during surgery: Group 1 (none, n = 43), Group 2 (1 transplant, n = 60), Group 3 (2 transplants, n = 67), and Group 4 (3 transplants, n = 24). Various clinical parameters were collected and compared among the groups.
RESULTS: Parathyroid autotransplantation was identified as a risk factor for temporary hypoparathyroidism (OR: 1.74; 95% CI: 1.27-2.39, P = 0.001) and a protective factor for permanent hypoparathyroidism (OR: 0.27; 95% CI: 0.14-0.55, P < 0.001). At 12 months postoperative, systemic parathyroid hormone (PTH) levels increased progressively from Groups 1 to 4, with significant differences observed only between Group 1 and Group 2 (P < 0.02). Difference values in systemic PTH levels between Month 1 and Day 1 postoperative increased progressively from Groups 1 to 4, with statistically significant differences observed between adjacent groups (P < 0.02). The number of dissected positive lymph nodes increased progressively across the four groups, showing statistical differences (P < 0.02).
CONCLUSIONS: Parathyroid autotransplantation can prevent permanent hypoparathyroidism. Additionally, we recommend preserving parathyroids in situ whenever possible. If autotransplantation is required, it should involve no more than two glands.
摘要：
背景：关于术中甲状旁腺自体移植是否能有效预防甲状腺切除术后永久性甲状旁腺功能减退症的争论仍在继续。本研究旨在研究其对术后甲状旁腺功能的影响，并确定最佳的自体移植策略。
方法：回顾性分析194例甲状腺乳头状癌（PTC）行甲状腺全切除术伴中央区淋巴结清扫（CLND）的患者。根据手术过程中甲状旁腺自体移植的数量将患者分为四组：第1组（无，n=43),第2组(1次移植，n=60),第3组（2次移植，n=67)，和第4组(3次移植，n=24）。收集各种临床参数并在组间进行比较。
结果：甲状旁腺自体移植被确定为暂时性甲状旁腺功能减退的危险因素（OR：1.74；95％CI：1.27-2.39，P=0.001）和永久性甲状旁腺功能减退的保护因素（OR：0.27；95％CI：0.14-0.55，P<0.001）。术后12个月，全身甲状旁腺激素(PTH)水平从第1组和第4组逐渐升高,仅在第1组和第2组之间观察到显著差异(P<0.02).术后第1个月和第1天之间的全身PTH水平的差异值从第1组到第4组逐渐增加，相邻组之间观察到统计学上的显着差异（P<0.02）。在四组中，解剖阳性淋巴结的数量逐渐增加，差异有统计学意义(P<0.02)。
结论：甲状旁腺自体移植可以预防永久性甲状旁腺功能减退。此外,我们建议尽可能在原位保存甲状旁腺。如果需要自体移植,它应该涉及不超过两个腺体。
方法：回顾性分析194例甲状腺乳头状癌（PTC）行甲状腺全切除术伴中央区淋巴结清扫（CLND）的患者。根据手术过程中甲状旁腺自体移植的数量将患者分为四组：第1组（无，n=43),第2组(1次移植，n=60),第3组（2次移植，n=67)，和第4组(3次移植，n=24）。收集各种临床参数并在组间进行比较。
结果：甲状旁腺自体移植被确定为暂时性甲状旁腺功能减退的危险因素（OR：1.74；95％CI：1.27-2.39，P=0.001）和永久性甲状旁腺功能减退的保护因素（OR：0.27；95％CI：0.14-0.55，P<0.001）。术后12个月，全身甲状旁腺激素(PTH)水平从第1组和第4组逐渐升高,仅在第1组和第2组之间观察到显著差异(P<0.02).术后第1个月和第1天之间的全身PTH水平的差异值从第1组到第4组逐渐增加，相邻组之间观察到统计学上的显着差异（P<0.02）。在四组中，解剖阳性淋巴结的数量逐渐增加，差异有统计学意义(P<0.02)。
结论：甲状旁腺自体移植可以预防永久性甲状旁腺功能减退。此外,我们建议尽可能在原位保存甲状旁腺。如果需要自体移植,它应该涉及不超过两个腺体。
