Ockert Stefan, Willeke Frank, Richter Axel, Jonescheit Jens, Schnuelle Peter, Van Der Woude Fokko, Post Stefan
Department of Surgery, University Hospital of Mannheim, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany.
Langenbecks Arch Surg. 2002 Oct;387(5-6):204-9. doi: 10.1007/s00423-002-0307-9. Epub 2002 Aug 14.
Total parathyroidectomy with autografting of parathyroid tissue and subtotal resection of the parathyroid glands are currently considered as standard surgical procedures for the treatment of severe secondary hyperparathyroidism. However, a considerable recurrence rate following these procedures ranges from 5% to 80%. We present a retrospective analysis of the results of parathyroidectomy with autotransplantation to the forearm versus parathyroidectomy alone.
We analyzed the clinical course of 11 consecutive patients who had undergone parathyroidectomy between 1995 and 1999, and who were not simultaneously autografted. Controls were 11 patients in whom autotransplantation of parathyroid tissue into the forearm had been routinely performed between 1993 and 1996 at our institution. Clinical symptoms and recurrence of hyperparathyroidism were assessed for comparison of the alternative treatment modalities. Recurrence of disease was defined by elevated parathormone (PTH) levels (>7.6 pmol/l) with clinical symptoms and/or need for reoperation.
No recurrence of hyperparathyroidism was observed in patients without autotransplantation after a mean follow-up of 23 months (range 1-49). Measurement of intact serum PTH revealed residual PTH secretion even after removal of four glands (mean 2.02 pmol/l). Clinical symptoms improved substantially after surgery. In the historical control group 3 of the 11 autotransplanted patients (27%) required resection of transplanted tissue. Additionally, two patients (18%) presented with increased PTH secretion and clinical symptoms of recurrent hyperparathyroidism during follow-up. Thus, a total of five patients (45%) experienced relapsing hyperparathyroidism caused by the implanted tissue.
Total parathyroidectomy without autotransplantation is a safe procedure with a low rate of recurrent hyperparathyroidism when compared to parathyroidectomy with autotransplantation to the forearm in a historical control. These preliminary results mandates further investigations including a randomized trial.
甲状旁腺全切除术加甲状旁腺组织自体移植以及甲状旁腺次全切除术目前被视为治疗重度继发性甲状旁腺功能亢进的标准外科手术。然而，这些手术之后的复发率相当高，在5%至80%之间。我们对甲状旁腺切除术后前臂自体移植与单纯甲状旁腺切除术的结果进行了回顾性分析。
我们分析了1995年至1999年间连续接受甲状旁腺切除术且未同时进行自体移植的11例患者的临床病程。对照组为1993年至1996年间在我们机构常规进行甲状旁腺组织前臂自体移植的11例患者。评估临床症状和甲状旁腺功能亢进的复发情况，以比较这两种替代治疗方式。疾病复发的定义为甲状旁腺激素（PTH）水平升高（>7.6 pmol/L）且伴有临床症状和/或需要再次手术。
未进行自体移植的患者在平均随访23个月（范围1 - 49个月）后未观察到甲状旁腺功能亢进复发。完整血清PTH的测量显示，即使切除了四个腺体后仍有残余PTH分泌（平均2.02 pmol/L）。术后临床症状显著改善。在历史对照组中，11例自体移植患者中有3例（27%）需要切除移植组织。此外，两名患者（18%）在随访期间出现PTH分泌增加和复发性甲状旁腺功能亢进的临床症状。因此，共有5例患者（45%）因植入组织出现复发性甲状旁腺功能亢进。
与历史对照组中甲状旁腺切除术后前臂自体移植相比，未进行自体移植的甲状旁腺全切除术是一种安全的手术，复发性甲状旁腺功能亢进发生率较低。这些初步结果需要进一步研究，包括随机试验。
