Uslu Adam, Okut Gokalp, Tercan Ismail Can, Erkul Zehra, Aykas Ahmet, Karatas Murat, Simsek Cenk, Tatar Erhan
Department of General Surgery and Transplantation.
Department of Pathology.
Medicine (Baltimore). 2019 Jun;98(23):e15926. doi: 10.1097/MD.0000000000015926.
The normal distribution of parathyroid glands is well documented. However, this study aims to evaluate the efficacy of total parathyroidectomy (TPTx) and bilateral cervical thymectomy (BCTx) for the treatment of secondary hyperparathyroidism (SHPT) through identifying the location of parathyroid glands with attention to the pattern and frequency of orthotopic and ectopic glands.Between 2013 and 2018, sixty chronic hemodialysis patients with medically refractory SHPT underwent TPTx & BCTx. The adequacy of the operation was defined by the pathological confirmation of at least 4 parathyroid glands, accompanied by an intact parathormone (iPTH) value of <60 pg/mL on postoperative day 1(POD1). Based on their anatomical localizations, four distinct sites were identified for both the upper (Zone I-IV) and lower parathyroid glands (Zone V-VIII).The mean follow-up was 15.2 ± 14.6 months. The mean iPTH values on POD1 were normal in 50 patients, with an average of 11.7 ± 14.4 pg/mL. Ten patients (16.6%) had persistent HPT after the operation, three of whom underwent complementary parathyroidectomy. The surgical success rates after first and second operations were both 83.3%. A total of 235 parathyroid glands were detected. Ninety-two percent of the upper parathyroids were located in Zones I and II. However, almost 28% of the lower parathyroids were ectopic and located in Zones VII and VIII.At least one fourth of the lower parathyroids are ectopic; for this reason, Zones VII and VIII require careful investigation during surgery. For upper parathyroids not found in Zone I-III, total thyroidectomy on the same side is recommended.
甲状旁腺的正常分布已有充分记录。然而，本研究旨在通过确定甲状旁腺的位置，关注原位和异位腺体的模式及频率，评估甲状旁腺全切除术（TPTx）和双侧颈胸腺切除术（BCTx）治疗继发性甲状旁腺功能亢进（SHPT）的疗效。2013年至2018年期间，60例药物治疗无效的慢性血液透析SHPT患者接受了TPTx和BCTx。手术的充分性定义为病理证实至少有4个甲状旁腺，且术后第1天（POD1）完整甲状旁腺激素（iPTH）值<60 pg/mL。根据其解剖位置，上甲状旁腺（I-IV区）和下甲状旁腺（V-VIII区）均确定了四个不同的部位。平均随访时间为15.2±14.6个月。50例患者POD1时的平均iPTH值正常，平均为11.7±14.4 pg/mL。10例患者（16.6%）术后持续存在甲状旁腺功能亢进，其中3例接受了补充性甲状旁腺切除术。首次和二次手术后的手术成功率均为83.3%。共检测到235个甲状旁腺。92%的上甲状旁腺位于I区和II区。然而，近28%的下甲状旁腺是异位的，位于VII区和VIII区。至少四分之一的下甲状旁腺是异位的；因此，手术期间VII区和VIII区需要仔细探查。对于在I-III区未发现的上甲状旁腺，建议同侧行甲状腺全切除术。
