Numano M, Tominaga Y, Uchida K, Orihara A, Tanaka Y, Takagi H
Department of Transplant Surgery, Kakegawa City General Hospital, Shizuoka, Japan.
World J Surg. 1998 Oct;22(10):1098-102; discussion 1103. doi: 10.1007/s002689900524.
In secondary hyperparathyroidism (2HPT) fundamentally all parathyroid glands, including supernumerary glands, become hyperplastic, and stimulation of parathyroid glands continues after parathyroidectomy (PTx). Therefore supernumerary glands have special significance during surgery for 2HPT, whether persistent or recurrent HPT. In the present study 570 patients underwent initial total PTx with a forearm autograft. The frequency, type, location, histopathology, and clinical significance of the supernumerary glands were evaluated. At the initial operation 90 supernumerary glands were removed from 82 to 570 patients (14.4%); 12 patients (2.1%) required extirpation of supernumerary glands for persistent/recurrent HPT. Altogether 104 supernumerary glands were identified at operation in 94 of the 570 patients (16.5%). Among these 104 glands, 25 (24.0%) were of the rudimentary, or split, type and 79 (76.0%) of the proper type. Supernumerary glands were most frequently identified in the thymic tongue (53/104, 51.0%); 32 (60.4%) of these 53 glands were identified only microscopically. In 6 of the 570 cases (1.1%), reoperation was required for persistent HPT due to supernumerary glands located in the mediastinum, and 6 patients underwent neck reexploration for recurrence. Histopathologically, 61 of 104 (58.7%) supernumerary glands, including 36 glands recognized only microscopically, showed diffuse hyperplasia, and 43 (41.3%) displayed nodular hyperplasia. Residual small supernumerary glands with diffuse hyperplasia have the potential to be transformed to nodular hyperplasia during long-term hemodialysis. Therefore all parathyroid glands including supernumerary glands should, if possible, be removed at the initial operation. Routine removal of the thymic tongue and careful examination of the regions surrounding the lower poles of the thyroid, especially on the left side, are important steps in the surgical treatment.
在继发性甲状旁腺功能亢进（2HPT）中，从根本上来说，所有甲状旁腺，包括额外的甲状旁腺，都会发生增生，并且甲状旁腺切除术后（PTx）甲状旁腺仍会持续受到刺激。因此，无论是持续性还是复发性HPT，额外的甲状旁腺在2HPT手术中都具有特殊意义。在本研究中，570例患者接受了初次全甲状旁腺切除术并进行了前臂自体移植。对额外甲状旁腺的频率、类型、位置、组织病理学及临床意义进行了评估。在初次手术时，从82至570例患者中切除了90个额外甲状旁腺（14.4%）；12例患者（2.1%）因持续性/复发性HPT需要切除额外甲状旁腺。在570例患者中的94例（16.5%）手术中总共发现了104个额外甲状旁腺。在这104个腺体中，25个（24.0%）为发育不全型或分裂型，79个（76.0%）为正常型。额外甲状旁腺最常出现在胸腺舌部（53/104，51.0%）；这53个腺体中的32个（60.4%）仅在显微镜下被发现。在570例病例中的6例（1.1%），由于位于纵隔的额外甲状旁腺导致持续性HPT而需要再次手术，6例患者因复发接受了颈部再次探查。组织病理学上，104个额外甲状旁腺中的61个（58.7%），包括仅在显微镜下识别出的36个腺体，表现为弥漫性增生，43个（41.3%）表现为结节性增生。残留的具有弥漫性增生的小额外甲状旁腺在长期血液透析过程中有可能转变为结节性增生。因此，所有甲状旁腺，包括额外甲状旁腺，如有可能，应在初次手术时切除。常规切除胸腺舌部并仔细检查甲状腺下极周围区域，尤其是左侧，是手术治疗中的重要步骤。
