Oran Ebru, Yetkin Gürkan, Mihmanlı Mehmet, Celayir Fevzi, Aygün Nurcihan, Çoruh Bestegül, Peker Evren, Uludağ Mehmet
Clinic of General Surgery, Şişli Etfal Training and Research Hospital, İstanbul, Turkey.
Clinic of Family Practice, Şişli Etfal Training and Research Hospital, İstanbul, Turkey.
Ulus Cerrahi Derg. 2015 Aug 18;32(1):6-10. doi: 10.5152/UCD.2015.3013. eCollection 2016.
Thyroidectomy is the most common cause of hypocalcemia. Preservation of parathyroid glands in situ is essential in preventing this complication. The aims of our study were to review patients who underwent parathyroid gland autotransplantation during thyroidectomy, and to compare hypocalcemia rates in patients with and without autotransplantation.
Parathyroid gland autotransplantation was performed in 43 (7.9%) of 543 patients who underwent thyroidectomy between 2008 and 2012.
Forty-four parathyroid glands were autotransplanted in 43 patients, including 36 women and 7 men. The median age was 55 (range: 30 to 68). The most common cause of autotransplantation was vascular comprise of the parathyroid gland. Early postoperative hypocalcemia developed in 37% of patients with autotransplantation, and none developed permanent hypocalcemia. Transient and permanent hypocalcemia rates were 9.6% and 0.4% in patients without autotransplantation, respectively. The risk of transient hypocalcemia was significantly high in patients with parathyroid autotransplantation (p<0.001). There was no difference between the two groups in terms of permanent hypocalcemia (p=0.156).
Despite meticulous dissection, parathyroid glands can be devascularized or removed inadvertently during thyroidectomy. Parathyroid autotransplantation is the best method to maintain parathyroid gland function. Although the risk of transient hypocalcemia is increased following parathyroid autotransplantation, long-term results are satisfactory.
甲状腺切除术是低钙血症最常见的病因。原位保留甲状旁腺对于预防这一并发症至关重要。我们研究的目的是回顾甲状腺切除术中接受甲状旁腺自体移植的患者，并比较有无自体移植患者的低钙血症发生率。
2008年至2012年间接受甲状腺切除术的543例患者中，43例（7.9%）进行了甲状旁腺自体移植。
43例患者共自体移植了44个甲状旁腺，其中女性36例，男性7例。中位年龄为55岁（范围：30至68岁）。自体移植最常见的原因是甲状旁腺血管受损。自体移植患者术后早期低钙血症发生率为37%，无一例发生永久性低钙血症。未进行自体移植的患者中，短暂性和永久性低钙血症发生率分别为9.6%和0.4%。甲状旁腺自体移植患者发生短暂性低钙血症的风险显著更高（p<0.001）。两组在永久性低钙血症方面无差异（p=0.156）。
尽管手术操作精细，但在甲状腺切除术中甲状旁腺仍可能意外地发生血管损伤或被切除。甲状旁腺自体移植是维持甲状旁腺功能的最佳方法。虽然甲状旁腺自体移植后短暂性低钙血症的风险增加，但长期效果令人满意。
