Nasiri S, Meshkati Yazd S M, Kamran H, Kahrizi M S, Azhdari M, Shahriarirad R
Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
J Endocrinol Invest. 2022 Dec;45(12):2291-2297. doi: 10.1007/s40618-022-01864-w. Epub 2022 Jul 18.
Total parathyroidectomy with autotransplantation is still an excellent treatment option for secondary hyperparathyroidism. Intramuscular or subcutaneous parathyroid autotransplantation has been previously reported; however, there have been no studies to date regarding the implantation of the parathyroid tissue in the subclavian area of the neck.
This was a prospective cross-sectional study between 2018 and 2019. Patients who underwent total parathyroidectomy with autotransplantation of parathyroid tissue into subcutaneous subclavicular area due to secondary hyperparathyroidism were included. The patients' demographic information, including age and gender, was gathered, and the length of the dialysis period was asked from the patients. To evaluate the outcome of the study, parathyroid hormone (PTH) was measured and recorded before and after the operation. SPSS software, version 26, was used for data analysis.
Forty-two patients with a mean age of 41.05 ± 9.41 years were included. The mean length of the dialysis period was 8.07 ± 2.68 years. The mean primary PTH was 1770.61 ± 482.97 pg/ml (range: 656-2500 <). After 6 weeks of operation, 19 patients (45.2%) had functional autotransplanted tissue, and the median PTH was 28 pg/ml (IQR: 33.55, range: 0.1-221.8). However, the results showed that after 10 weeks, the patients with functional tissue were increased to 22 (52.4%), and the median PTH was 35 pg/ml (IQR: 48, range: 5.0-602.9). The functionality of autotransplanted tissue in the 6th and 10th weeks after surgery had no significant association with age, gender, and length of the dialysis period (p value > 0.05).
Subcutaneous implantation is recommended in the treatment of secondary hyperparathyroidism based on its high success rate and ease of use, suitable vascularization, easy accessibility to the surgery location in case of the need for autographtectomy.
甲状旁腺全切术加自体移植仍是治疗继发性甲状旁腺功能亢进的一种极佳选择。此前已有肌内或皮下甲状旁腺自体移植的报道；然而，迄今为止尚无关于将甲状旁腺组织植入颈部锁骨下区域的研究。
这是一项2018年至2019年的前瞻性横断面研究。纳入因继发性甲状旁腺功能亢进接受甲状旁腺全切术并将甲状旁腺组织自体移植至锁骨下皮下区域的患者。收集患者的人口统计学信息，包括年龄和性别，并询问患者的透析时长。为评估研究结果，在手术前后测量并记录甲状旁腺激素（PTH）。使用SPSS 26版软件进行数据分析。
纳入42例患者，平均年龄为41.05±9.41岁。平均透析时长为8.07±2.68年。术前平均原发性PTH为1770.61±482.97 pg/ml（范围：656 - 2500<）。术后6周，19例患者（45.2%）有功能正常的自体移植组织，PTH中位数为28 pg/ml（四分位间距：33.55，范围：0.1 - 221.8）。然而，结果显示术后10周，有功能组织的患者增至22例（52.4%），PTH中位数为35 pg/ml（四分位间距：48，范围：5.0 - 602.9）。术后第6周和第10周自体移植组织的功能与年龄、性别及透析时长无显著关联（p值>0.05）。
基于皮下植入治疗继发性甲状旁腺功能亢进成功率高、使用方便、血管化良好且在需要自体移植切除时手术部位易于到达，建议采用皮下植入。
