Casella Claudio, Galani Alessandro, Totaro Luigi, Ministrini Silvia, Lai Silvia, Dimko Mira, Portolani Nazario
Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy.
Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
Int J Endocrinol. 2018 Jul 9;2018:6065720. doi: 10.1155/2018/6065720. eCollection 2018.
Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation.
A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat.
A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group ( = 0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism ( = 0.387). 2 patients showed persistent hyperparathyroidism ( = 0.816), and in 2 others was found recurrent hyperparathyroidism ( = 0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit.
The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice.
继发性甲状旁腺功能亢进在慢性肾脏病中很常见。当药物治疗无法将甲状旁腺激素水平降至可接受值而不引起明显的高磷血症或高钙血症时，甲状旁腺切除术适用于难治性甲状旁腺功能亢进。本研究的目的是比较前臂皮下自体移植甲状旁腺全切术与前臂肌肉内自体移植甲状旁腺全切术的疗效和安全性。
对2002年1月至2013年2月行前臂自体移植甲状旁腺全切术的单中心回顾性队列研究。根据手术技术，患者分为肌肉内移植组（第1组）和皮下移植组（第2组）。纳入38例继发性甲状旁腺功能亢进患者；23例患者接受了甲状旁腺全切术，并将甲状旁腺组织重新植入非优势上肢前臂皮下，15例患者接受了肌肉内植入。
共纳入38例患者（56±13岁）。两组患者术前iPTH值均显著升高，肌肉内自体移植组为1750±619 pg/ml，皮下自体移植组为1527±451 pg/ml（P=0.079）。7例患者出现短暂性甲状旁腺功能减退，1例患者出现持续性甲状旁腺功能减退（P=0.387）。2例患者出现持续性甲状旁腺功能亢进（P=0.816），另外2例患者出现复发性甲状旁腺功能亢进（P=0.816）；其中3例患者接受了自体移植切除术。1例肌肉内自体移植患者出现功能性手臂缺损，前臂非优势侧前室受损。
非优势上肢前臂皮下甲状旁腺组织自体移植的疗效和安全性得到证实，组织植入率良好，两种技术术后短暂性和持续性甲状旁腺功能减退及甲状旁腺功能亢进的发生率相当。此外，该技术在自体移植切除术中保留了手臂功能。因此，我们认为前臂皮下自体移植甲状旁腺全切术是目前的最佳选择。
