Anamaterou Chrysanthi, Lang Matthias, Schimmack Simon, Rudofsky Gottfried, Büchler Markus W, Schmitz-Winnenthal Hubertus
Department of Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
BMC Surg. 2015 Oct 15;15:113. doi: 10.1186/s12893-015-0098-x.
Surgical management of renal secondary hyperparathyroidism (sHPT) is varying. Total parathyroidectomy with heterotopic autotransplantation (TPTX + AT) is one of the standard surgical procedures in sHPT, but there is no consensus about the optimal site for graft insertion. At the surgical department of the University Hospital of Heidelberg we prefer the autotransplantation into the tibialis anterior muscle. The aim of this study was to assess the long-term function of the auto-transplanted parathyroid tissue in this type of surgical procedure.
The function of the autograft of 42 patients was assessed 8.2 ± 2.5 years after surgery, using a modified Casanova-test of the leg bearing the parathyroid tissue. Ischemic blockage was induced by tourniquet and the levels of parathyroid hormone (PTH) were assessed during the test.
At the point of assessment, the ischemic blockage led to a significant reduction in the concentration of PTH (≥50% of the baseline value) in 19 patients (45%) indicating well-functioning autografts. In 11 patients (26%), ischemic blockage did not cause any change in the concentration of PTH (≤20% of the baseline value), indicating functioning residual parathyroid tissue from another site. The source of PTH production was classified as unidentifiable in five patients (12%). Two patients had developed graft-dependent recurrent HPT (5%) without therapeutic consequences and three patients suffered from persistent symptomatic hypoparathyroidism (7%).
These results indicate that TPTX + AT into the tibialis anterior muscle is a successful surgical treatment for renal HPT and that the modified Casanova-test is a suitable diagnostic tool for autografts function.
肾性继发性甲状旁腺功能亢进（sHPT）的手术治疗方式各异。甲状旁腺全切术加异位自体移植（TPTX + AT）是sHPT的标准手术方法之一，但关于移植的最佳部位尚无共识。在海德堡大学医院外科，我们更倾向于将甲状旁腺自体移植到胫骨前肌。本研究的目的是评估这种手术方式中自体移植甲状旁腺组织的长期功能。
对42例患者在术后8.2±2.5年采用改良的卡萨诺瓦试验评估移植到有甲状旁腺组织一侧下肢的自体移植组织的功能。使用止血带造成缺血性阻断，并在试验期间评估甲状旁腺激素（PTH）水平。
在评估时，缺血性阻断导致19例患者（45%）的PTH浓度显著降低（≥基线值的50%），表明自体移植组织功能良好。11例患者（26%）中，缺血性阻断未导致PTH浓度发生任何变化（≤基线值的20%），表明其他部位存在有功能的残余甲状旁腺组织。5例患者（12%）的PTH产生来源无法确定。2例患者发生了移植依赖的复发性HPT（5%），但未产生治疗后果，3例患者患有持续性症状性甲状旁腺功能减退（7%）。
这些结果表明，将甲状旁腺全切术加自体移植到胫骨前肌是治疗肾性HPT的一种成功手术方法，改良的卡萨诺瓦试验是评估自体移植组织功能的合适诊断工具。
