Ander S, Johansson K, Smeds S
Department of Endocrinology and Metabolism, University Hospital, Linköping, Sweden.
World J Surg. 1996 Jun;20(5):598-601; discussion 602. doi: 10.1007/pl00012250.
The blood supply of pathologic parathyroid glands and the relation between parathyroid hormone secretion and parathyroid blood perfusion was studied during surgery for hyperparathyroidism. Blood flow in 39 single adenomas and 20 glands classified as primary or secondary hyperplasia were studied intraoperatively with laser Doppler flowmetry. The ipsilateral inferior thyroid artery was occluded during continuous flowmetry recording, which resulted in a 40% reduction of parathyroid blood flow in both groups. In 12 patients with single adenomas, intact parathormone (iPTH) was measured intraoperatively before and during occlusion of the ipsilateral inferior thyroid artery and after extirpation of the adenoma. During occlusion the iPTH levels were mainly unchanged despite blood flow reduction of up to 80%. After removal of the adenoma the iPTH normalized within 15 minutes. In a control group of eight single adenomas, iPTH was measured similarly without vascular occlusion, demonstrating comparable iPTH levels. This study demonstrates similar routes of vascularization for single adenomas and hyperplastic glands, as was earlier seen for normal parathyroid glands. The increased parathyroid hormone secretion from single adenomas appears to remain mainly unchanged during significant blood flow reduction.
在甲状旁腺功能亢进症手术期间，研究了病理性甲状旁腺的血液供应以及甲状旁腺激素分泌与甲状旁腺血液灌注之间的关系。术中使用激光多普勒血流仪对39个单发腺瘤和20个分类为原发性或继发性增生的腺体的血流情况进行了研究。在连续血流测量记录过程中，阻断同侧甲状腺下动脉，结果两组甲状旁腺血流均减少40%。在12例单发腺瘤患者中，术中在阻断同侧甲状腺下动脉前、阻断期间以及切除腺瘤后测量了完整甲状旁腺激素（iPTH）。阻断期间，尽管血流减少高达80%，但iPTH水平主要保持不变。切除腺瘤后，iPTH在15分钟内恢复正常。在一个由8个单发腺瘤组成的对照组中，在不进行血管阻断的情况下进行了类似的iPTH测量，显示出可比的iPTH水平。本研究表明，单发腺瘤和增生性腺体的血管化途径相似，这与之前在正常甲状旁腺中观察到的情况相同。在血流显著减少期间，单发腺瘤中甲状旁腺激素分泌增加的情况似乎主要保持不变。
