Objective To summarize the development, clinical application, advantages and disadvantages, and future prospects of parathyroid autofluorescence in recent years. MethodThe literatures related to the research progress of parathyroid autofluorescence in recent years were searched, and launched a specific discussion. Results Autofluorescence of parathyroid gland was still in its infancy at home and abroad. The existing studies had shown that this technique was superior to visual recognition and could reduce the incidence of postoperative complications. Autofluorescence technology had shown some advantages in identifying parathyroid gland during operation, and its mechanism research and related equipment improvement should be focused in the future. ConclusionAutofluorescence technique is of great value in the identification of parathyroid glands in patients undergoing thyroidectomy or parathyroidectomy.
Objective To explore the application value of intraoperative gamma detector in patients with chronic kidney disease secondary hyperparathyroidism (sHPT) undergoing total parathyroidectomy (tPTX)+auto transplantation (AT). Methods A retrospective analysis of the clinical data of 110 sHPT patients who received tPTX+AT at Northern Jiangsu Province People’s Hospital from July 2014 to June 2019 was performed. Among them, 80 patients underwent tPTX+AT guided by the gamma detector during the operation (observation group), 30 patients underwent tPTX+AT under routine exploration (control group). We compared the operation time, number of parathyroid glands removed, serum intact parathyroid hormone (iPTH) concentration, serum calcium and phosphorus levels, as well as the occurrence of postoperative complications and recurrence rate were compared between the two groups. Results The number of parathyroid glands removed of the control group was lower than that of the observation group [(3.87±0.35) per case vs. (4.01±0.11) per case, P<0.05], but the operation time of the control group was longer [(115±25) min vs. (75±27) min, P<0.05]. Postoperative iPTH, serum calcium and serum phosphorus levels were significantly reduced in all patients. After the operation, the symptoms of pruritus, bone pain, and muscle weakness were relieved or disappeared. There was no death, dysphagia, drinking water choking cough, and superior laryngeal nerve injury occurred. One patient in the observation group and one patient in the control group had hoarseness, and one patient in the control group had cervical incision bleeding; one patient in the observation group and four patients in the control group suffered short-term postoperative recurrence due to incomplete parathyroidectomy. There was no significant difference in the incidence of complications (χ2=2.413, P>0.05), but the short-term postoperative recurrence rate of the observation group was lower than that of the control group (χ2=7.342, P<0.05). Conclusion Gamma detector is helpful for rapid identification of typical hyperplasia and ectopic parathyroid glands during operation, and can improve the accuracy of tPTX , save operation time, and reduce the recurrence.
Secondary and tertiary hyperparathyroidism are common complications in patients with chronic kidney disease, especially in end stage renal disease. Surgery is an important method for the treatment of secondary and tertiary hyperparathyroidism. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism is the first evidence based guideline focus on renal hyperparathyroidism surgical management. Recommendations using the best available evidence by a panel of 10 experts in secondary and tertiary renal hyperparathyroidism constructed this guideline, which provides evidence-based, individual and optimal surgical management of secondary and tertiary renal hyperparathyroidism. This paper made a guideline interpretation on the indications of surgery, imaging examination, preoperative and perioperative management, relevant evaluation and treatment during perioperative period, and intraoperative parathyroid hormone monitoring during operation, and so on.
Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively. Results There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperativeserum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case ofadenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 monthsprior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up. Conclusions The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.
【Abstract】ObjectiveTo investigate the effect of xenotransplantation of microencapsulated rabbit parathyroid tissue in different sites in rats for the treatment of hypoparathyroidism. MethodsThe parathyroid glands from Wistar rats were removed to make them aparathyroid. Ultimately, sixteen rats were included because their serum calcium values were continuously below 1.6 mmol/L. We also encapsulated the cultured rabbit parathyroid tissue with alginateBaCl2 microcapsule. According to the transplantation sites, rats were randomly divided into two groups: renal adipose microcapsule group and peritoneal microcapsule group, eight in each group. Encapsulated rabbit parathyroid tissues were then transplanted accordingly to different microcapsule groups. The calcium serum contents were examined on 5，15，25，35，45，55 and 65 d respectively after transplantation and the grafts were observed through electron microscope on the 65 d in particular. ResultsThe calcium contents after transplantation in renal adipose microcapsule group restored to normal and the observation outcomes of grafts showed that they survived well. The calcium contents of posttransplantation in peritoneal group also restored to normal with an exception that it dropped to a level lower than 1.6 mmol/L on the 65 d. Electron microscope also showed that there were necrotic tissues in the center and only a few cells survived on the edge of the grafts. Within peritoneal microcapsule group, the values were significantly lower than others taken at different phases. ConclusionMicroencapsulated rabbit parathyroid tissue that was xenotransplanted into rats can survive and function without administration of immunodepressant. There are significant differences of calcium contents at varying phases between two transplantation sites, which demonstrate that renal adipose may be an optimal site for microcapsule xenotransplantation.
ObjectiveTo investigate the effectiveness of probe-based near infrared autofluorescence (AF) technology in the identification and functional protection of parathyroid gland (PG) during endoscopic total thyroidectomy. MethodsWe retrospectively collected the clinical data of 160 patients who underwent total thyroidectomy with bilateral central compartment lymph node dissection due to papillary thyroid carcinoma in Chongqing General Hospital from 1 July 2023 to 31 January 2024. Among them, 80 patients who used probe-based near infrared AF technology to identify the PGs were categorized as the AF group, 80 patients who used naked eye (NE) to identify the PGs were categorized as the NE group. The number of PGs identified, inadvertently removed, preserved in situ and autotransplanted, the incidence of postoperative hypoparathyroidism, and operative time were compared between the two groups. ResultsThe incidence of transient hypoparathyroidism was significantly lower in the AF group than that of the NE group [21.25% (17/80) vs. 43.75% (35/80), χ2=9.231, P=0.002], with no cases of permanent hypoparathyroidism in either group. The AF group had significantly more PGs identified and preserved in situ than the NE group (P<0.05) , but had significantly fewer PGs inadvertently removed and autotransplanted than the NE group (P<0.05). The AF group identified the first PG earlier than the NE group (4 min vs. 5 min, P<0.001). But there was no statistically difference in the operative time between the two groups (90 min vs. 94 min, P=0.052). ConclusionThe probe-based near infrared AF technology can help surgeons better identify and protect PGs during surgery, reducing the incidence of postoperative transient hypoparathyroidism.
ObjectiveTo understand the methods of judging the blood supply of parathyroid during thyroidectomy at home and abroad in recent years. MethodThe literature on parathyroid blood supply was collected, the research progress was reviewed, and the advantages and disadvantages of related methods were analyzed. ResultsIn recent years, near-infrared fluorescence, laser speckle contrast imaging and other technologies had been applied. They showed better advantages as compared with naked eye observation. The research on parathyroid blood supply at home and abroad was still in its infancy, and more clinical samples and related equipment optimization were still needed. ConclusionFluorescence imaging technology has a certain auxiliary role in the judgment of intraoperative parathyroid blood supply and can reduce the incidence of hypoparathyroidism to a certain extent.
Objective To explore the protection of the structure and function around the upper pole of the thyroid gland by endoscopic thyroidectomy combined with nerve detection through the gasless unilateral axillary approach. Methods From January 2019 to June 2020, 48 thyroid patients who underwent the gasless unilateral axillary approach combined with the endoscopy and nerve detection technology in the Department of Head and Neck Surgery of Zhejiang Provincial People’s Hospital were reviewed as the endoscopic group, and 53 thyroid patients underwent open surgery combined with the endoscopy and nerve detection technology as the open group. The protection of the functional structure of the suprathyroid pole were compared. Results In terms of operation time, the endoscopic group was longer than that of the open group (67.5 min vs. 54.1 min, P=0.001). There was no statistical difference between the two groups in terms of postoperative hospital stay and blood loss (P>0.05). Forty-seven patients with the endoscopic thyroid surgery through the gasless unilateral axillary approach effectively detected the superior laryngeal nerve (47/48, 97.9%), which was higher than that of the open group (40/53, 75.5%), P=0.003, and the exposure rate of hypoglossal nerve descending branch in the endoscopic group was also higher [31.3% (15/48) vs. 3.8% (2/53), P=0.001]. In the endoscopic group, the superior parathyroid gland was kept in situ during the operation, and there was no change of voice and cough after the operation. In the open group, there were 2 cases of autologous transplantation of the upper pole parathyroid gland, 2 patients had voice changes, and 1 case had partial upper pole banded muscle incision. There was no significant difference in the incidence of nerve injury complications, the rate of autologous transplantation of the upper pole parathyroid gland and the rate of anterior cervical banded muscle injury between the two groups (P>0.05). In addition, there was no significant difference in the levels of parathyroid hormone, blood calcium, blood magnesium and blood phosphorus between the two groups before/after operation (P>0.05). Conclusion During the endoscopic thyroidectomy through the gasless unilateral axillary approach, the nerve monitoring technology is combined with the exploration and protection of the superior laryngeal nerve on the surface of the medial cricothyroid muscle of the upper pole of the thyroid, and the fine capsule anatomy technology is used to protect the superior parathyroid gland in situ, which can more effectively expose the external branch of the superior laryngeal nerve. It is conducive to the protection of the structures around the upper pole.
Objective To culture primary parathyroid cells by mean of simulated microgravity, observe their basic morphological characteristics, study survival rate and secretory function of parathyroid cells, and explore more excellent culture mean of parathyroid cells. Methods There were 37 male Wistar rats, the body weight was 150–200 g. The rat was intraperitoneally injected with 1% pentobarbital sodium (50 mg/kg). The parathyroid glands were surgically excised and identified pathologically. The parathyroid gland cells were got and digested them with collagenase Ⅱ, which were divided into three groups: conventional culture group (simple parathyroid cells were cultured), polyglycolic acid (PGA) scaffold culture group (the parathyroid cells were cultured on the PGA scaffold), and simulated microgravity culture group (the parathyroid cells and PGA scaffolds were cultured in simulated microgravity environment). The parathyroid cells were cultured for 1, 3, 5 or 7 days in different culture conditions, then the parathyroid hormone (PTH) was measured, morphological characteristics of the parathyroid cell was observed under phase contrast microscope, survival rate of the parathyroid cells was calculated by acridine orange/propidium iodide staining. Results The parathyroid cell morphologies of most cells were well and center of part of cell mass was necrosis on day 7 in the conventional culture group. The most parathyroid cells were spreading toward the poles along the PGA cell scaffold in the longitudinal direction and the adjacent stents were connected by extracellular matrix on day 7 in the PGA scaffold culture group. The parathyroid cells cultured under the simulated microgravity were got round and formed clusters on day 7 in the simulated microgravity culture group. Compared with the other two groups on day 7, the PTH and the survival rate of the parathyroid cells were significantly higher in the simulated microgravity culture group (P<0.05). Conclusions Parathyroid cells cultured in simulated microgravity environment could maintain better morphology, survival rate is higher, and secretory function is better. Therefore, parathyroid cells cultured in simulated microgravity could be used as good donor cell for treatment of hypoparathyroidism. PGA scaffold could be used as a good carrier for culture of parathyroid cell.
ObjectiveTo explore the clinical significance of detecting serum intact parathyroid hormone (iPTH) and drainage fluid parathyroid hormone (dPTH) after thyroidectomy in forecasting parathyroid function.MethodsThe clinical data of 95 thyroidectomy patients in the same treatment group from March 2018 to September 2018 were retrospectively analyzed, which in the Department of Thyroid-Breast Surgery, the Second Affiliated Hospital of Kunming Medical University. According to the surgical method, the patients were divided into 3 groups: isthmus and unilateral thyroidectomy (partial resection group, n=33), total thyroidectomy (total resection group, n=33) and total thyroidectomy and central lymph node excision (radical resection group, n=29). The negative pressure drainage tube was placed in the operative area. The iPTH and serum calcium were detected before and the first day after operation. The dPTH was detected in the first day and the second day after operation. Serum calcium, iPTH and dPTH were statistically analyzed.ResultsThere were no significant differences in operative time, hospital stay and blood loss between the total resection group and the radical resection group (P>0.05), but the partial resection group were all less than the other two groups (P<0.01). On the first day after operation, the iPTH in the three groups were lower than that before operation, and the iPTH was significantly decreased in the total resection group and the radical resection group, with statistically significant difference (P<0.05). The dPTH in the three groups were significantly increased on the first and second day after operation (P<0.05), but there was no statistically significant difference between the three groups (P>0.05). There was no statistically significant difference in serum calcium between the three groups on the first day after operation (P>0.05).ConclusionsThe levels of iPTH, dPTH and serum calcium after thyroidectomy can comprehensively forecast the parathyroid function. Preventive calcium supplementation can reduce the occurrence of postoperative symptomatic hypocalcemia, which is conducive to the recovery of parathyroid function.