Meta-analysis Of Parathyroid Function After Parathyroid Autotransplantation Versus Situ Preservation

Objective:To compare the effects of PA(parathyroid autotransplantation)and parathyroid gland preservation in situ on parathyroid function after thyroidectomy,so as to provide reference for clinical decision-making.Methods:From the databases of Web of Science,Cochrane Library,Pub Med,China Biomedical Literature Database,cnki,wanfang,Weipu,etc.,all clinical studies on PA and parathyroid gland preservation in situ before December 2022 were retrieved.The literature was integrated according to the inclusion criteria,and the relevant clinical data and data were collected and sorted,meta-analysis was performed using revman 5.4software.Results:A total of 3807 cases were included in 18 articles,including 1864 cases in the autologous transplantation group and 1943 cases in the orthotopic preservation group.Meta results showed that blood calcium levels were higher in the first month after PA surgery(WMD=0.08,95% CI(0.04,0 13)P=0.0002],the PTH(Parathyroid hormone)level was higher one month after PA surgery(WMD=3.70,95% CI(0.24,7.17)P=0.04),with a statistically significant difference.In the two groups,temporary HPT(Hypoparathyroidism)(OR=1.70,95% CI(0.94,3.09)P=0.08),permanent HPT(OR=0.71,95% CI(0.38,1.35)P=0.30),blood calcium level on the first postoperative day(WMD=-0.08,95% CI(-0.16,0.00)P=0.06),blood calcium level on the third postoperative day(WMD=-0.04,95% CI(-0.12,0.05)P=0.40),and blood calcium level on the seventh postoperative day(WMD=0.01,95% CI(-0.09,0.11)P=0.82)There was no statistically significant difference in PTH levels at the first postoperative day(WMD=-4.23,95% CI(-8.50,0.05)P=0.05),at the third postoperative day(WMD=-1.70,95% CI(-9.95,6.54)P=0.69),and at the seventh postoperative day(WMD=1.03,95% CI(-4.71,6.77)P=0.72)(P ≥0.05).Conclusion:Both PA and parathyroid gland in situ preservation were safe and reliable in clinical efficacy,and PA and parathyroid gland in situ preservation had no effect on the risk of transient or permanent HPT after operation in the early postoperative period,PA and parathyroid gland preservation in situ had no significant effect on the recovery of parathyroid function,PA was helpful to the recovery of parathyroid function 1 month after operation.When the parathyroid gland was cut by mistake or the blood supply was damaged,immediate PA was recommended to protect the parathyroid function effectively.