Monchik J M, Bendinelli C, Passero M A, Roggin K K
Rhode Island Hospital, Department of Endocrine Surgery, Providence, USA.
Surgery. 1999 Dec;126(6):1152-8; discussion 1158-9. doi: 10.1067/msy.2099.101427.
Parathyroidectomy is required in up to 5% of patients with chronic renal failure. Intramuscular transplantation of autologous parathyroid tissue in the forearm has been the traditional method of transplantation at the time of total parathyroidectomy. The removal of an intramuscular transplantation can be technically difficult should graft-dependent hyperparathyroidism (GRH) occur. This problem resulted in our initiating a study of subcutaneous transplantation with total parathyroidectomy in patients with renal failure.
Twenty-six patients who were receiving dialysis therapy underwent total parathyroidectomy and subcutaneous transplantation. Parathyroid tissue was diced into 1- to 2-mm pieces, and 6 pieces were grafted into 6 subcutaneous pockets of the forearm. Intact parathyroid hormone was measured within 48 hours of operation and in the bilateral antecubital veins 1 to 24 months after the operation to assess completeness of resection and graft function, respectively.
No major surgical complications occurred. Symptoms improved in 24 patients (85%). Graft failure rate was 4.3%. No GRH was observed. Follow-up was 4 to 55 months (mean, 27 months).
This study indicates that the subcutaneous transplantation function is comparable to intramuscular transplantation and suggests a decreased incidence of GRH. Subcutaneous transplantation is technically easier than intramuscular transplantation and has the additional advantage of easy removal should GRH occur.
高达5%的慢性肾衰竭患者需要进行甲状旁腺切除术。在甲状旁腺全切术时，将自体甲状旁腺组织肌内移植到前臂一直是传统的移植方法。如果发生移植物依赖性甲状旁腺功能亢进（GRH），切除肌内移植组织在技术上可能会很困难。这个问题促使我们开展了一项针对肾衰竭患者进行甲状旁腺全切术并皮下移植的研究。
26例接受透析治疗的患者接受了甲状旁腺全切术和皮下移植。将甲状旁腺组织切成1至2毫米的小块，6块移植到前臂的6个皮下囊袋中。分别在术后48小时内及术后1至24个月测量双侧肘前静脉中的完整甲状旁腺激素，以评估切除的彻底性和移植物功能。
未发生重大手术并发症。24例患者（85%）症状改善。移植物失败率为4.3%。未观察到GRH。随访时间为4至55个月（平均27个月）。
本研究表明皮下移植功能与肌内移植相当，并提示GRH的发生率降低。皮下移植在技术上比肌内移植更容易，并且如果发生GRH，还有易于切除的额外优势。
