Kihara M, Yokomise H, Miyauchi A, Matsusaka K
Second Department of Surgery, Kagawa Medical University, Kita-gun, Japan.
Surg Today. 2000;30(4):333-8. doi: 10.1007/s005950050596.
To prevent postoperative hypoparathyroidism following total thyroidectomy, the parathyroid glands are preserved in situ and/or resected or devascularized parathyroid glands are autotransplanted. We conducted a retrospective investigation utilizing biochemical and specific endocrine assessments to evaluate the difference in recovery of parathyroid function between the two operative methods. A total of 92 patients underwent total thyroidectomy at our hospital during the period between 1990 and 1997. These patients were divided into a preservation group (n = 83), with one or more preserved glands in situ, and an autotransplantation group (n = 9), with only transplanted glands. The level of intact parathyroid hormone (PTH) was completely restored by 1 year postoperatively in 83% (69/83) of the preservation group patients. In the remaining 14 patients (17%), the intact PTH had fallen below detectable levels on postoperative day (POD) 1, then subsequently recovered to 70% of the preoperative levels. Comparatively, in the autotransplantation group, the mean level of intact PTH recovered to only 43% of the preoperative levels. The results of this study suggest that parathyroid glands should be preserved in situ whenever possible, and that when intact PTH levels fall below detectable limits on POD 1, they may never recover to the preoperative levels in those patients.
为预防全甲状腺切除术后甲状旁腺功能减退，甲状旁腺被原位保留和/或切除或血运障碍的甲状旁腺被自体移植。我们进行了一项回顾性研究，利用生化和特定内分泌评估来评估两种手术方法在甲状旁腺功能恢复方面的差异。1990年至1997年期间，我院共有92例患者接受了全甲状腺切除术。这些患者被分为保留组（n = 83），原位保留一个或多个甲状旁腺，以及自体移植组（n = 9），仅移植甲状旁腺。保留组83%（69/83）的患者术后1年时完整甲状旁腺激素（PTH）水平完全恢复。其余14例患者（17%）中，完整PTH在术后第1天（POD 1）降至可检测水平以下，随后恢复到术前水平的70%。相比之下，在自体移植组中，完整PTH的平均水平仅恢复到术前水平的43%。本研究结果表明，应尽可能原位保留甲状旁腺，并且当完整PTH水平在POD 1时降至可检测极限以下时，这些患者可能永远无法恢复到术前水平。
