Blomme R A M, Blomme A M, Rinkes I H M Borel, Meerwaldt R, van der Wal M B A, Valk G D, Vriens M R
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Acta Chir Belg. 2010 Jan-Feb;110(1):35-9. doi: 10.1080/00015458.2010.11680562.
Although total parathyroidectomy with forearm autotransplantation is a widely accepted treatment for patients with secondary/tertiary hyperparathyroidism (HPT) some debate persists about the optimal surgical strategy. In particular, the question what to do when less than four parathyroid glands can be found during surgery has yet to be resolved. The aim of this retrospective study was to review the outcome of total parathyroidectomy with autotransplantation and to assess the proper procedure (to autotransplant or not) when finding less than 4 glands after extensive surgical exploration.
Between 1995 and 2005, parathyroidectomy was performed in 74 patients in two affiliated centers. In this case-control study both clinical and biochemical outcomes of a total or subtotal parathyroidectomy were compared. The parathyroid hormone (PTH), serum calcium concentration, phosphate and alkaline phosphatase levels were monitored preoperatively, 1 and 12 months postoperatively.
Sixty five patients underwent a total parathyroidectomy and nine patients underwent a subtotal parathyroidectomy. Persistent HPT was seen in nine patients (12%). Recurrent HPT was seen in eight patients (11%). There were no significant differences between the group with > or = 4 glands excised and the group with three glands excised regarding serum PTH levels after 12 months and the number of patients with a hypo- or hyperparathyroidism (persistent or recurrent). Procedure related morbidity was minimal.
Total parathyroidectomy with forearm autotransplantation is safe and effective for patients with secondary/tertiary hyperparathyroidism. In case of not finding a fourth gland after extensive surgical exploration, our general advice is to proceed as planned with the autotransplantation.
尽管甲状旁腺全切术加前臂自体移植术是治疗继发性/三发性甲状旁腺功能亢进症（HPT）患者的一种广泛接受的治疗方法，但关于最佳手术策略仍存在一些争议。特别是，手术中发现少于四个甲状旁腺时该如何处理的问题尚未得到解决。这项回顾性研究的目的是回顾甲状旁腺全切术加自体移植术的结果，并评估在广泛手术探查后发现少于4个甲状旁腺时的正确手术步骤（是否进行自体移植）。
1995年至2005年期间，两个附属医院的74例患者接受了甲状旁腺切除术。在这项病例对照研究中，比较了甲状旁腺全切术或次全切术的临床和生化结果。术前、术后1个月和12个月监测甲状旁腺激素（PTH）、血清钙浓度、磷酸盐和碱性磷酸酶水平。
65例患者接受了甲状旁腺全切术，9例患者接受了甲状旁腺次全切术。9例患者（12%）出现持续性HPT。8例患者（11%）出现复发性HPT。切除≥4个甲状旁腺的组与切除3个甲状旁腺的组在术后12个月时的血清PTH水平以及甲状旁腺功能减退或亢进（持续性或复发性）患者数量方面没有显著差异。手术相关并发症极少。
甲状旁腺全切术加前臂自体移植术对继发性/三发性甲状旁腺功能亢进症患者是安全有效的。在广泛手术探查后未发现第四个甲状旁腺的情况下，我们的一般建议是按计划进行自体移植。
