Brunt L M, Sicard G A
Department of Surgery, Washington University School of Medicine, St. Louis.
Semin Surg Oncol. 1990;6(2):115-21. doi: 10.1002/ssu.2980060210.
Autotransplantation of the parathyroid glands is a clinically useful modality for the management of patients with certain forms of hyperparathyroidism. In conjunction with total parathyroidectomy, this procedure has been used to treat patients with primary and secondary hyperparathyroidism who have generalized parathyroid hyperplasia. Parathyroid autotransplantation is also an important adjunct to the management of patients undergoing radical thyroid or laryngeal surgery to prevent permanent hypoparathyroidism from devascularization of all in situ parathyroid tissue. The technique of parathyroid cryopreservation has been well established and provides surgeons with greater flexibility in the approach to patients undergoing reoperative parathyroid surgery in whom there is uncertainty about the functional status of the remaining parathyroid tissue. Parathyroid allotransplantation has been successfully performed in immunosuppressed patients but is rarely indicated. Parathyroid autografts can be placed heterotopically in a forearm muscle or in the sternocleidomastoid, but the former site is preferred in patients with hyperplastic or adenomatous tissue. This technique results in a low incidence of permanent hypoparathyroidism after radical parathyroidectomy, and recurrent hypercalcemia can be easily managed by local excision of a portion of the grafted tissue.
甲状旁腺自体移植是治疗某些形式甲状旁腺功能亢进患者的一种临床有用方法。与甲状旁腺全切术联合使用时，该手术已用于治疗患有弥漫性甲状旁腺增生的原发性和继发性甲状旁腺功能亢进患者。甲状旁腺自体移植也是根治性甲状腺或喉部手术患者管理中的一项重要辅助措施，以防止所有原位甲状旁腺组织因血管供应中断而导致永久性甲状旁腺功能减退。甲状旁腺冷冻保存技术已经成熟，为再次进行甲状旁腺手术且对剩余甲状旁腺组织功能状态存在疑问的患者提供了更大的手术灵活性。甲状旁腺同种异体移植已在免疫抑制患者中成功实施，但很少应用。甲状旁腺自体移植可异位植入前臂肌肉或胸锁乳突肌，但对于增生性或腺瘤样组织患者，前者更为可取。该技术在根治性甲状旁腺切除术后导致永久性甲状旁腺功能减退的发生率较低，复发性高钙血症可通过局部切除部分移植组织轻松处理。
