Department of Transplant and Endocrine Surgery, Nagoya Second Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 4668650, Japan.
World J Surg. 2010 Jun;34(6):1312-7. doi: 10.1007/s00268-010-0412-9.
Recurrent renal hyperparathyroidism (HPT) is a serious problem after parathyroidectomy (PTx). We evaluated the frequency of graft-dependent recurrent HPT and the clinical outcomes after removal of the autograft.
Between March 1980 and January 2009, 2660 patients underwent total PTx with forearm autograft. After resection of all parathyroid glands, 30 pieces of 1 x 1 x 3 mm parathyroid tissue from diffuse hyperplasia, if possible, were autografted into brachioradial muscle. Graft-dependent recurrence of HPT was diagnosed by a high PTH gradient and detection of swollen autografts by palpation and/or MRI or US.
In 248/2660 (9.3%) patients, removal of the graft was required a total of 327 times (53 patients required removal of the autograft several times). The cumulative frequency of graft-dependent recurrent HPT was 17.4% ten years after the initial PTx. Thirty-two patients underwent both resection of missed glands located in the neck or mediastinum and removal of the graft. En-bloc resection of autograft with surrounding muscle was required to avoid reoperation. When the intact PTH level dropped under 300 pg/ml, in the majority of patients renal HPT could be medically managed after the operation. The mean weight of the resected parathyroid tissue was 1583.7 mg. No specimen had histopathologically malignant features. Three patients suffered from hematoma in the wound.
Graft-dependent recurrent renal HPT is not negligible. However, in the majority of patients, renal HPT can be controlled by removal of the autograft noninvasively. Total PTx with forearm autograft is preferable for hemodialysis patients, especially when long-term survival is expected.
甲状旁腺切除术后（PTx），复发性甲状旁腺功能亢进症（HPT）是一个严重的问题。我们评估了移植物依赖性复发性 HPT 的频率以及切除自体移植物后的临床结果。
1980 年 3 月至 2009 年 1 月，2660 例患者接受了全甲状旁腺切除术和前臂自体移植。切除所有甲状旁腺后，如果可能，将 30 片 1 x 1 x 3 毫米弥漫性增生的甲状旁腺组织自体移植到肱桡肌中。通过高 PTH 梯度和触诊和/或 MRI 或 US 检测肿胀的自体移植物来诊断移植物依赖性 HPT 复发。
在 2660 例患者中的 248 例（9.3%）中，总共需要切除移植物 327 次（53 例患者需要多次切除自体移植物）。初始 PTx 后 10 年，移植物依赖性复发性 HPT 的累积频率为 17.4%。32 例患者均接受了颈部或纵隔中遗漏的腺体切除术和移植物切除术。为避免再次手术，需要整块切除自体移植物及其周围肌肉。当完整的 PTH 水平降至 300 pg/ml 以下时，大多数患者术后可通过药物治疗控制肾性 HPT。切除的甲状旁腺组织平均重量为 1583.7 毫克。没有标本具有组织病理学恶性特征。有 3 例患者伤口血肿。
移植物依赖性复发性肾 HPT 不容忽视。然而，在大多数患者中，肾 HPT 可以通过非侵入性切除自体移植物来控制。对于血液透析患者，尤其是预期长期生存的患者，全甲状旁腺切除术和前臂自体移植更可取。
