Sitges-Serra Antonio, Lorente-Poch Leyre, Sancho Juan
Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain.
Department of Surgery, Hospital del Mar, PasseigMarítim 25-29, 08003, Barcelona, Spain.
Langenbecks Arch Surg. 2018 May;403(3):309-315. doi: 10.1007/s00423-018-1654-5. Epub 2018 Feb 10.
Careful parathyroid gland dissection and in situ preservation was the time-honored approach to prevent parathyroid failure after total thyroidectomy. The relative success of parathyroid autotransplantation of hyperplastic parathyroid tissue in patients with renal or hereditary hyperparathyroidism did popularize the use of normal parathyroid tissue autografts during thyroidectomy to prevent permanent hypoparathyroidism. Proof of autograft function in this setting, however, is controversial.
This narrative review aims at reviewing critically the current status of parathyroid autotransplantation during total thyroidectomy. It is also meant to analyze from the historical, methodological, and clinical points of view the claimed benefit of normal parathyroid gland autotransplantation. A focus is placed on the prevention of permanent hypoparathyroidism by parathyroid autotransplantation.
Liberal parathyroid autotransplantation was proposed in the mid 1970s but evidence of function is scarce. Proofs are accumulating that parathyroid autografts not only increase the rate of postoperative hypocalcemia, but may be also contribute to permanent hypoparathyroidism.
仔细解剖甲状旁腺并原位保留是全甲状腺切除术后预防甲状旁腺功能减退的传统方法。肾性或遗传性甲状旁腺功能亢进患者增生甲状旁腺组织自体移植的相对成功，确实使甲状腺切除术中使用正常甲状旁腺组织自体移植以预防永久性甲状旁腺功能减退的做法得到普及。然而，在这种情况下自体移植功能的证据存在争议。
本叙述性综述旨在批判性地回顾全甲状腺切除术中甲状旁腺自体移植的现状。它还旨在从历史、方法学和临床角度分析正常甲状旁腺自体移植所宣称的益处。重点在于通过甲状旁腺自体移植预防永久性甲状旁腺功能减退。
20世纪70年代中期有人提出广泛进行甲状旁腺自体移植，但功能证据稀少。越来越多的证据表明，甲状旁腺自体移植不仅会增加术后低钙血症的发生率，还可能导致永久性甲状旁腺功能减退。
