Noussios G, Anagnostis P, Natsis K
Laboratory of Anatomy in Department of Physical Education and Sports Medicine, Aristotle University of Thessaloniki, Greece.
Exp Clin Endocrinol Diabetes. 2012 Nov;120(10):604-10. doi: 10.1055/s-0032-1327628. Epub 2012 Nov 22.
Ectopic parathyroid glands result from aberrant migration during early stages of development and lack of successful identification may lead to lack of success in parathyroid surgery. They constitute a common etiology of persistent or recurrent hyperparathyroidism, when they are missed at initial diagnosis. Their prevalence is about 2-43% in anatomical series and up to 16% and 14% in patients with primary and secondary hyperparathyroidism, respectively. Ectopic inferior parathyroids are most frequently found in the anterior mediastinum, in association with the thymus or the thyroid gland, while the most common position for ectopic superior parathyroids is the tracheoesophageal groove and retroesophageal region. Neck ultrasound and 99mTc Sestamibi scan are first-line imaging modalities, although with low sensitivity and specificity. However, their combination with modern techniques, such as single photon emission computed tomography (SPECT) alone or in combination with CT (SPECT/CT) increases their diagnostic accuracy. Fine needle-aspiration cytology of a lesion suspicious for parathyroid tissue and measurement of parathyroid hormone (PTH) in the aspired material further assist to the successful preoperative localization of ectopic glands. Common sites for surgical investigation are the upper thyroid pole and the upper vascular thyroid stalk behind the hypopharynx and cervical esophagus for the superior parathyroids, and the carotid artery bifurcation and the thymic tongue, for the inferior parathyroids. Radioguided minimally invasive parathyroidectomy after successful localization, assisted by rapid PTH measurement postoperatively, significantly improves surgical outcomes in patients with ectopic parathyroid adenomas.
异位甲状旁腺是由于发育早期迁移异常所致，未能成功识别可能导致甲状旁腺手术失败。初诊时若遗漏异位甲状旁腺，它们是持续性或复发性甲状旁腺功能亢进的常见病因。在解剖学系列研究中，其发生率约为2% - 43%，在原发性和继发性甲状旁腺功能亢进患者中分别高达16%和14%。异位下甲状旁腺最常见于前纵隔，与胸腺或甲状腺相关，而异位上甲状旁腺最常见的位置是气管食管沟和食管后区域。颈部超声和99mTc甲氧基异丁基异腈扫描是一线成像方式，尽管其敏感性和特异性较低。然而，将它们与现代技术（如单独的单光子发射计算机断层扫描（SPECT）或与CT联合（SPECT/CT））相结合可提高其诊断准确性。对可疑甲状旁腺组织的病变进行细针穿刺细胞学检查，并在抽吸物中测量甲状旁腺激素（PTH），进一步有助于术前成功定位异位腺体。手术探查的常见部位是上甲状旁腺位于下咽和颈段食管后方的甲状腺上极和甲状腺上血管蒂，下甲状旁腺位于颈动脉分叉处和胸腺舌叶。成功定位后，在术后快速PTH测量的辅助下进行放射性引导的微创甲状旁腺切除术，可显著改善异位甲状旁腺腺瘤患者的手术效果。
