Famà Fausto, Cicciù Marco, Polito Francesca, Cascio Antonio, Gioffré-Florio Maria, Piquard Arnaud, Saint-Marc Olivier, Sindoni Alessandro
Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy.
Complesso MITO, Residenza Ginestre F/2, 98151, Messina, Italy.
World J Surg. 2017 Feb;41(2):457-463. doi: 10.1007/s00268-016-3754-0.
Parathyroid autotransplantation is an easy procedure with a low complication rate. We adopted the transplantation into the sternocleidomastoid muscle, which allows an easier and time-saving surgical procedure using the same surgical incision.
In this study, we retrospectively reviewed the records of 396 consecutive patients, who underwent total thyroidectomy for benign thyroid disease. In all cases in which a parathyroid was damaged or inadvertently removed, the gland was transplanted; before the autotransplantation, the parathyroid tissue was put in a cell culture nutrient solution for 5 min, afterward fragmented, and then was transplanted in the sternocleidomastoid muscle. To demonstrate a beneficial effect of the cell nutrient solution step, we compared data of transplanted patients with a control group of cases (n = 190) undergoing a standard immediate autotransplantation.
We divided patients in two main groups: group A (n = 160) including subjects that underwent one or more parathyroid gland autotransplantation using the cell nutrient solution, and group B (n = 236) concerning those who were not transplanted. Among patients, 62 hypocalcemias occurred, 40 in the group A and 22 in the group B (P < 0.001): 91.9 % were transient and 8.1 % (5 patients) definitive, all pertaining to the group B. Among controls (group C), 42 hypocalcemias occurred (P = 0.616 vs. group A and P = 0.002 vs. group B) and 3/42 became definitive (P = 0.096 vs. group A and P = 0.121 vs. group B). All differences concerning pre- and postoperative calcium values were statistically significant (P < 0.001).
We recommend the routine parathyroid autotransplantation, when a vascular damage is certain or suspected, in order to reduce the rate of permanent hypoparathyroidism, using a cell culture nutrient solution before gland transplantation.
甲状旁腺自体移植是一种操作简单、并发症发生率低的手术。我们采用将甲状旁腺移植到胸锁乳突肌的方法，这样在同一手术切口下手术操作更简便、省时。
在本研究中，我们回顾性分析了396例因良性甲状腺疾病接受全甲状腺切除术患者的记录。在所有甲状旁腺受损或被意外切除的病例中，均进行了甲状旁腺移植；自体移植前，将甲状旁腺组织置于细胞培养液中5分钟，然后切碎，再移植到胸锁乳突肌中。为了证明细胞培养液步骤的有益效果，我们将移植患者的数据与一组接受标准即刻自体移植的对照组病例（n = 190）进行了比较。
我们将患者分为两个主要组：A组（n = 160）包括使用细胞培养液进行一次或多次甲状旁腺自体移植的患者，B组（n = 236）为未进行移植的患者。患者中发生了62例低钙血症，A组40例，B组22例（P < 0.001）：91.9%为短暂性，8.1%（5例患者）为永久性，均属于B组。在对照组（C组）中，发生了42例低钙血症（与A组相比P = 0.616，与B组相比P = 0.002），其中3/42例变为永久性（与A组相比P = 0.096，与B组相比P = 0.121）。所有术前和术后钙值的差异均具有统计学意义（P < 0.001）。
我们建议，当确定或怀疑有血管损伤时，常规进行甲状旁腺自体移植，以降低永久性甲状旁腺功能减退的发生率，在腺体移植前使用细胞培养液。
