Wells S A, Farndon J R, Dale J K, Leight G S, Dilley W G
Ann Surg. 1980;192(4):451-8. doi: 10.1097/00000658-198010000-00003.
Since 1973, we have performed total parathyroidectomy and forearm parathyroid autotransplantation in 36 patients with generalized (four gland) primary parathyroid hyperplasia. Twenty (56%) patients had nonfamilial parathyroid hyperplasia (NFPH) and 16 (44%) patients had familial parathyroid hyperplasia (FPH). Twenty-one patients (Group A) were undergoing operation for the first time and 15 (Group B) were having either second, third or fourth re-explorations for persistent hyperparathyroidism. All patients in Group A and nine patients in Group B had parathyroid resection and immediate autotransplantation as a single procedure. Six Group B patients had hyperfunctioning parathyroid tissue resected, cryopreserved, and subsequently grafted when it was evident that they had been rendered aparathyroid. A sustained differential elevation (13.7 fold +/- 2.7) of parathyroid hormone was detected in the antecubital vein of the grafted compared to the nongrafted arm in 35 (97%) patients. Two (5.6%) of the 36 patients (both with FPH; one Group A and one Group B) required permanent oral calcium and vitamin D replacement therapy and one (3%) patient (NFPH: Group A) had persistent hypercalcemia postoperatively, presumably due to a supernumerary gland. The remaining 33 (92%) patients became normocalcemia after surgery and 23 (70%) of them remained so. Ten (30%) of the 33 patients developed recurrent graft dependent hyperparathyroidism. Eight patients were from the group with FPH (8/14, 57%) and two were from the group with NFPH (2/19, 11%)(FPH vs. NFPH, p < 0.005). Because of symptoms of hypercalcemia or a serum calcium concentration exceeding 11 mg/dl, partial graft resection was performed in five patients and four became normocalcemic. Patients with generalized primary parathyroid hyperplasia may be difficult to cure, especially if the disease is familial. The technique of total parathyroidectomy and heterotopic autotransplantation of fresh or cryopreserved parathyroid tissue offers distinct advantages over alternative techniques.
自1973年以来，我们对36例广泛性（四个腺体）原发性甲状旁腺增生患者进行了甲状旁腺全切除术及前臂甲状旁腺自体移植术。20例（56%）患者患有非家族性甲状旁腺增生（NFPH），16例（44%）患者患有家族性甲状旁腺增生（FPH）。21例患者（A组）首次接受手术，15例（B组）因持续性甲状旁腺功能亢进接受第二次、第三次或第四次再次探查手术。A组所有患者及B组9例患者将甲状旁腺切除及即刻自体移植作为一个单一手术操作。6例B组患者切除功能亢进的甲状旁腺组织，冷冻保存，当明显出现甲状旁腺缺失时随后进行移植。35例（97%）患者移植侧肘前静脉与未移植侧相比，甲状旁腺激素持续出现差异升高（13.7倍±2.7）。36例患者中有2例（5.6%）（均为FPH；1例A组，1例B组）需要长期口服钙剂及维生素D替代治疗，1例（3%）患者（NFPH：A组）术后持续高钙血症，可能是由于存在一个额外的腺体。其余33例（92%）患者术后血钙恢复正常，其中23例（70%）一直保持正常。33例患者中有10例（30%）发生移植依赖型复发性甲状旁腺功能亢进。8例患者来自FPH组（8/14，57%），2例来自NFPH组（2/19，11%）（FPH组与NFPH组相比，p<0.005）。由于出现高钙血症症状或血清钙浓度超过11mg/dl，5例患者进行了部分移植组织切除，4例血钙恢复正常。广泛性原发性甲状旁腺增生患者可能难以治愈，尤其是疾病为家族性时。甲状旁腺全切除术及新鲜或冷冻保存的甲状旁腺组织异位自体移植技术相较于其他替代技术具有明显优势。
