Lo Chung-Yau
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China.
ANZ J Surg. 2002 Dec;72(12):902-7. doi: 10.1046/j.1445-2197.2002.02580.x.
Permanent hypoparathyroidism is a debilitating morbidity following thyroidectomy, with a reported incidence of up to 43%. Apart from meticulous dissection to preserve parathyroid glands and their blood supply, parathyroid autotransplantation (PA) has been increasingly employed to preserve parathyroid function. The adoption of PA during thyroidectomy has been reported to be associated with a low incidence of permanent hypoparathyroidism. Biochemical function of parathyroid autografts can be demonstrated objectively by forearm reimplantation or during long-term follow up. The clearest indication for PA is for inadvertently removed or devascularized parathyroid glands during thyroid surgery. Other strategies, including routine autotransplantation of at least one parathyroid gland, can be considered, but is associated with a high incidence of transient hypocalcaemia. Apart from refinement in technique to facilitate graft success, a reliable way to assess overall parathyroid function or viability of individual parathyroid gland may assist in monitoring parathyroid function and selecting patients requiring this procedure to prevent permanent hypoparathyroidism.
永久性甲状旁腺功能减退是甲状腺切除术后一种使人衰弱的病症，据报道其发生率高达43%。除了进行细致解剖以保留甲状旁腺及其血供外，甲状旁腺自体移植（PA）已越来越多地用于保留甲状旁腺功能。据报道，在甲状腺切除术中采用PA与永久性甲状旁腺功能减退的低发生率相关。甲状旁腺自体移植的生化功能可通过前臂再植或在长期随访中客观地得到证实。PA最明确的指征是在甲状腺手术中甲状旁腺被意外切除或血供中断。其他策略，包括常规自体移植至少一个甲状旁腺，也可予以考虑，但这与短暂性低钙血症的高发生率相关。除了改进技术以提高移植成功率外，一种评估整体甲状旁腺功能或单个甲状旁腺活力的可靠方法可能有助于监测甲状旁腺功能，并选择需要进行此手术的患者以预防永久性甲状旁腺功能减退。
