Pattou F N, Pellissier L C, Noël C, Wambergue F, Huglo D G, Proye C A
Department of General and Endocrine Surgery, University Hospital, 59037 Lille, France.
World J Surg. 2000 Nov;24(11):1330-4. doi: 10.1007/s002680010220.
Supernumerary parathyroid glands (SPGs) are found in 13% of random autopsies. The high incidence of SPGs could explain the persistence or trigger recurrence of renal hyperparathyroidism after surgery. The aim of this study was to assess the frequency and clinical relevance of SPG in patients operated on for renal hyperparathyroidism (HPT). In this retrospective study we reviewed the medical records of 290 patients with renal HPT who were initially treated in our department. We examined the anatomic and pathologic findings during cervical surgical exploration and the outcome of HPT during follow-up. SPGs were identified in 87 patients (30%) during the initial cervicotomy, corresponding to intrathymic parathyroid cell islets (one to four) in 70 cases and to extrathymic SPG in 17 patients. Among 260 patients available for follow-up, 11 experienced persistent HPT (4%), and 34 developed recurrent HPT (13%). A total of 25 patients were reoperated on, and SPGs were responsible for 4 of 8 cases of persistent HPT and 4 of 17 cases of recurrent HPT, representing an overall frequency of 32%. The anatomic distribution of SPGs found during reoperations included thymus, retroesophageal grove, carotid sheath, and mediastinum. SPGs are thus present in 30% of patients with renal HPT and are situated mainly in the thymus. Thymectomy should be performed routinely during the first surgical exploration to prevent recurrences arising from anterior mediastinal glands. SPGs were also responsible for 32% of persistent or recurrent HPT. In that setting, frankly ectopic SPGs are not rare, and preoperative imaging appears highly desirable prior to embarking on surgical reexploration.
在13%的随机尸检中发现有额外甲状旁腺（SPG）。SPG的高发生率可以解释肾性甲状旁腺功能亢进症手术后疾病的持续存在或复发。本研究的目的是评估接受肾性甲状旁腺功能亢进症（HPT）手术患者中SPG的发生率及其临床相关性。在这项回顾性研究中，我们查阅了最初在我科接受治疗的290例肾性HPT患者的病历。我们检查了颈部手术探查时的解剖和病理结果以及随访期间HPT的结局。在初次颈部切开术中，87例患者（30%）发现有SPG，其中70例为胸腺内甲状旁腺细胞小岛（1至4个），17例为胸腺外SPG。在可供随访的260例患者中，11例出现持续性HPT（4%），34例出现复发性HPT（13%）。共有25例患者接受了再次手术，SPG导致了8例持续性HPT中的4例以及17例复发性HPT中的4例，总体发生率为32%。再次手术时发现的SPG的解剖分布包括胸腺、食管后沟、颈动脉鞘和纵隔。因此，30%的肾性HPT患者存在SPG，且主要位于胸腺。在首次手术探查时应常规进行胸腺切除术，以防止前纵隔腺体引起的复发。SPG还导致了32%的持续性或复发性HPT。在这种情况下，明显异位的SPG并不罕见，在进行手术再次探查之前，术前影像学检查似乎非常必要。
