Tominaga Y, Tanaka Y, Sato K, Numano M, Uchida K, Falkmer U, Grimelius L, Johansson H, Takagi H
Department of Transplant Surgery, Nagoya Second Red Cross Hospital, Japan.
World J Surg. 1992 Jul-Aug;16(4):595-602; discussion 602-3. doi: 10.1007/BF02067331.
In spite of recent therapeutic advances, severe overt secondary hyperparathyroidism due to chronic renal failure necessitates parathyroidectomy and recurrent hyperparathyroidism is one of the most significant problems in this patient population. In the present study, the incidence of recurrent hyperparathyroidism was evaluated in relation to the histopathological features. Image cytometric DNA analysis was performed to estimate the proliferative potential of parathyroid tissue. The study comprised 248 patients who underwent parathyroidectomy from 1973 to 1991. The frequency of recurrent hyperparathyroidism after subtotal parathyroidectomy was 4 (21.1%) of 19 patients, the rate of graft-dependent recurrence after removal of residual parathyroid tissue with forearm autograft was 2 (50%) of 4 patients. The frequency of graft-dependent recurrence after total parathyroidectomy with forearm autograft was 16 (7.5%) of 212 patients. The frequency of recurrence was significantly higher (p less than 0.01) when nodular hyperplastic parathyroid tissue was autografted (17 of 68 patients, 25%) than when diffuse-hyperplastic tissue was grafted (1 of 105 patients, less than 1%). All 58 specimens subjected to image cytometric DNA analysis showed a diploid nuclear pattern cytometrically. However, the relative number of scattered cells that displayed cytometric nuclear DNA values outside the main diploid histogram peak was significantly greater (p less than 0.01) in nodular hyperplastic tissue before being autografted and in parathyroid tissue removed at re-operation performed for recurrence than in diffuse hyperplastic tissue. These clinical findings and results of DNA analysis clearly indicated that nodular hyperplastic parathyroid tissue has a higher growth potential, and it is concluded that to prevent graft-dependent recurrence, the nodular type of hyperplastic tissue should not be autografted.
尽管近年来治疗方法有所进步，但慢性肾衰竭所致的严重显性继发性甲状旁腺功能亢进仍需进行甲状旁腺切除术，而复发性甲状旁腺功能亢进是该患者群体中最严重的问题之一。在本研究中，我们根据组织病理学特征评估了复发性甲状旁腺功能亢进的发生率。进行图像细胞仪DNA分析以评估甲状旁腺组织的增殖潜力。本研究纳入了1973年至1991年间接受甲状旁腺切除术的248例患者。次全甲状旁腺切除术后复发性甲状旁腺功能亢进的发生率为19例中的4例（21.1%），在前臂自体移植切除残余甲状旁腺组织后，移植依赖型复发率为4例中的2例（50%）。在前臂自体移植的全甲状旁腺切除术后，移植依赖型复发率为212例中的16例（7.5%）。当结节性增生的甲状旁腺组织进行自体移植时（68例患者中的17例，25%），复发频率显著高于弥漫性增生组织移植时（105例患者中的1例，<1%）（p<0.01）。所有58份接受图像细胞仪DNA分析的标本在细胞仪上均显示二倍体核型。然而，在自体移植前的结节性增生组织以及复发再次手术时切除的甲状旁腺组织中，显示细胞仪核DNA值在主要二倍体直方图峰值之外的散在细胞的相对数量显著多于弥漫性增生组织（p<0.01）。这些临床发现和DNA分析结果清楚地表明，结节性增生的甲状旁腺组织具有更高的生长潜力，因此得出结论，为防止移植依赖型复发，不应将结节型增生组织进行自体移植。
