ObjectiveTo assess the clinical efficacy of percutaneous transplantation of parathyroid glands into the subcutaneous tissue of the epigastrium for treating malignant secondary hyperparathyroidism (SHPT). MethodsThe clinical data of the patients with SHPT who were treated by puncturing the subcutaneous tissue of the epigastrium and transplanting parathyroid glands in the Xuzhou Central Hospital from January 2020 to June 2022 were collected retrospectively. The preoperative and postoperative parathyroid hormone (PTH) level, calcium ion concentration, alkaline phosphatase (ALP) level, and phosphorus ion concentration, as well as postoperative follow-up results were analyzed. The data analysis was conducted using SPSS 23.0 software, with a testing level of 0.01. ResultsA total of 21 patients successfully underwent this surgery, including 12 males and 9 females, with a median age of 48 years old and a range of 32–71 years old. The dialysis time was (8.62±2.27) years, and 12 patients had hypertension, 9 patients had anemia, 17 patients had bone pain, and 11 patients had skin itching. On day 1 after treatment, the PTH level decreased from (1 893.23±539.30) ng/L to (5.99±3.50) ng/L (P<0.001), the calcium ion concentration decreased from (2.52±0.31) mmol/L to (2.24±0.35) mmol/L (P=0.003), and the phosphorus ion concentration decreased from (2.25±0.71) mmol/L to (1.76±0.38) mmol/L (P=0.006) as compared with the values before surgery. Although the ALP level decreased from (321.78±151.01) U/L to (229.32±89.32) U/L, there was no statistically significant difference (P=0.016). Among the 12 patients with hypertension before surgery, 6 patients improved and reduced the use of antihypertensive drugs after surgery; among the 9 patients with anemia, 3 patients improved before discharge; 17 patients with bone pain showed markedly relief before discharge; and 9 patients with skin itching improved before discharge. There were no complications such as hoarseness, choking cough when drinking water, or incision infection after the operation. All 21 patients were followed up for 6–12 months. The parathyroid hormone levels of the 21 patients all dropped to the normal level within 12 months after the operation. Among them, 3 patients recovered to the normal level at the 3rd month after the operation, 16 patients recovered to the normal level at the 6th month after the operation, and 2 patients recovered to the normal level at the 12th month after the operation. The time to return to the normal level was (5.86±2.70) months. No serious complications occurred in all patients, and there was no recurrent case during follow-up period. Conclusion From the analysis results of our study, parathyroid autotransplantation into the subcutaneous tissue of the epigastrium via puncture is a safe and effective method for patients with SHPT.
ObjectiveTo compare postoperatively clinical effect of endoscopic total thyroidectomy via breast approach versus traditional total thyroidectomy via neck in treatment of thyroid papillary carcinoma on postoperative function of parathyroid gland. MethodsRetrospective study performed on 124 thyroid papillary carcinoma patients who were hospitalized between June 2014 and December 2015 in Department of General Surgery of The First Affiliated Hospital of General Hospital of PLA. All patients underwent total thyroidectomy plus central Ⅵ lymphadenectomy. Endoscopic total thyroidectomy via breast were applied on 48 patients and traditional total thyroidectomy via neck were applied on 76 patients. Serum intact parathyroid hormone (iPTH) and calcium on postoperative day 1 were monitored for all patients. Then comparison of the serum iPTH and calcium between the 2 groups was performed. ResultsSerum iPTH and calcium for all 124 patients were within the normal range before surgery, and there was no significant difference between the endoscopic total thyroidectomy via breast group and traditional total thyroidectomy via neck group in the serum iPTH and calcium (P > 0.05). On 1 day after surgery, the level of iPTH in endoscopic total thyroidectomy via breast group was lower than that of traditional total thyroidectomy via neck group[(20.8±5.7) pg/mL vs. (28.3±4.9) pg/mL], and ratio of lower iPTH than normal of endoscopic total thyroidectomy via breast group was higher[43.8% (21/48) vs. 22.4% (17/76)], P < 0.05; but there was no significant difference in serum calcium between 2 groups[(2.1±0.3) mmol/L vs. (2.0±0.5) mmol/L], P > 0.05. In addition, the incidence of perioral, chiral and pedal numbness was higher in endoscopic total thyroidectomy via breast group than that of traditional total thyroidectomy via neck group[47.9% (23/48) vs. 27.6% (21/76)], P < 0.05. ConclusionsComparably, endoscopic total thyroidectomy via breast approach is more prone to lowly postoperative serum iPTH and calcium. Patients are more prone to exhibit clinical symptom such as perioral numbness, chiral and pedal numbness.
Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.
This is the first successful case expriences,a method of the procurement of the fetal cadavertic multiple argans for transplantation of the pancreas and thyroid-pararthyroid glands was produced. The liver,pancreas,duodenum,spleen,and both kidneys were harvested en bloc by a group of surgeons,and the right hem-ithyroid-parathyroid glands with pedicle of thd blood vessels wre removed by another group.The pancreas together with the spleen were transplanted to a patient having diabetes mellitus. The thyroid-parathyroid glands were given to another case with bypothyroidism and hypoparathyroidism.Both cases had good results.This method had dicreased the warm ischemia of the transplants,and could provide liver,pancreas,spleen,kidneys and thyroid-parathyroid glands to solve the problem of shortage of fetal organs.
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 recognize the intraoperative recognition of parathyroid gland optical technology and explore its application value in thyroid surgery to protect the parathyroid gland.MethodsLiterature review was conducted on the principle and application status of intraoperative recognition of parathyroid gland optical technology by using " thyroidectomy” " parathyroid gland” " Near-Infrared imaging” " laser speckle contrast imaging”, and " optical coherence tomography” as retrieval terms to retrieve literatures.ResultsIntraoperative optical technique alone or in combination with contrast agent could improve the recognition rate of parathyroid gland, reduce the damage of feeding vessels, and thus reduce the incidence of postoperative hypocalcemia.ConclusionsTraditional intraoperative parathyroid gland recognition methods needs to be improved in real-time protection effectiveness and accuracy, and the combination of new optical technology and contrast agent can largely make up for these shortcomings, but there are still obstacles in the promotion.
Objective To understand anatomy of parathyroid gland and explore its application value in protection of parathyroid gland function during thyroidectomy. Methods The literatures, which were associated with the parathyroid anatomy and hypoparathyroidism were collected. The origin, function, anatomical location, number, blood supply, lymphatic system of the parathyroid gland and its relationship with surrounding tissues of parathyroid gland and its clinical significance in the thyroidectomy, were reviewed. Results The position of the superior parathyroid gland was relatively constant, and the inferior parathyroid gland was more likely to be ectopic. The number of the parathyroid gland was uncertain. The mainstream view was that the arterial supply of the parathyroid glands was mainly ensured by the inferior thyroid artery, a few by anastomosis of the superior and inferior thyroid arteries, or by the superior thyroid artery. However, the alternative view was that the blood supply of the parathyroid gland was not mainly derived from the inferior thyroid artery. The parathyroid gland was not easily distinguished from the adipose tissue and lymph node. Whether there was an independent lymphatic system in the parathyroid gland was still controversial. In the thyroidectomy, the parathyroid gland and its blood supply were reserved or protected by distinguishing from the Zuckerkandl tubercle, recurrent laryngeal nerve, and parathyroid specific attachment fat, which were identified by utilizing of the nanocarbon, loupe magnification, etc.. Especially in the central lymph neck dissection, the main thyroid artery trunk and its important branches should be carefully dissected or retained through the gentle capsular dissection and the correct use of energy devices for vessel sealing. The parathyroid gland in situ was reserved according to the parathyroid type. If it was not possible to be preserved, the parathyroid autotransplantation was necessary during the thyroidectomy. Conclusions Understanding origin and location of parathyroid gland, it could provide a direction for searching parathyroid gland during thyroidectomy. Being familiar with blood supply of parathyroid gland makes it possible to protect blood vessel and preserve parathyroid gland. Gentle capsular dissection, rational use of energy device, and indocyanine green angiography seem to be more important. Number of parathyroid gland allows us to treat each parathyroid gland as the last one, if it is not preserved in situ , parathyroid gland need to be autografted to avoid hypoparathyroidism.
ObjectiveTo investigate the clinical value of fine needle aspiration cytology (FNAC) combined with washout fluid detection of parathyroid hormone (PTH) in identifying parathyroid glands during thyroid cancer radical thyroidectomy. MethodsA total of 108 patients who underwent thyroid cancer radical thyroidectomy in Rizhao Central Hospital from June 2020 to December 2022 were selected as the study subjects. During the surgery, highly suspected parathyroid tissues were punctured with fine needle aspiration. FNAC and washout fluid were collected for PTH detection. Using the results of postoperative histopathological examination as the gold standard, the accuracy of different methods in identifying parathyroid glands during surgery was analyzed. ResultsAmong the 73 positive cases, the PTH level in the washout fluid was (591.20±84.30) pg/mL, while in the 35 negative cases, it was (18.69±2.53) pg/mL. The PTH level was significantly higher in the positive cases compared to the negative cases (P＜0.05). Postoperative routine histopathological examination confirmed parathyroid tissues in 91 cases, while in 17 cases, they were confirmed as adipose tissues (11 cases) or lymphoid tissues (6 cases). In the 17 cases confirmed as non-parathyroid tissues, both two methods considered them as non-parathyroid tissues. The sensitivity of puncture eluent in detecting PTH was 80.22% (73/91), that of cytological smear was 70.33% (64/91), and that of puncture eluent combined with cytological smear was 94.50% (86/91). There was no significant difference between the sensitivity of puncture cytology smear and puncture eluent in detecting PTH (P＞0.05). The sensitivity of combined detection of the two methods was higher than that of individual detection, and the difference was statistically significant (P<0.05). ConclusionThe combined detection of PTH by fine needle puncture smear and eluent can improve the accuracy of identification of parathyroid gland during radical thyroidectomy, and is beneficial to the identification and protection of parathyroid gland during surgery.
ObjectiveTo summarize the latest progress of parathyroid gland identification in thyroid surgery, and to provide some reference for improving the clinical efficacy.MethodThe literatures about the identification of parathyroid gland in thyroid surgery in recent years were collected to make an review.ResultsThere were many methods for identifying parathyroid gland in thyroid surgery, such as naked eye identification method, intraoperative frozen section, intraoperative staining identification method, intraoperative optical identification method, intraoperative parathyroid hormone assay, γ-detector, and histological identification, each method had its own advantages and disadvantages.ConclusionThe identification of parathyroid gland does not only depend on a certain method, but also require surgeons to enhance their ability to distinguish parathyroid gland.
ObjectiveTo explore the clinical application of near-infrared autofluorescence (NIRAF) detection technology in protecting the parathyroid glands and the research progress on the autofluorescent substances. MethodThe recent literature on clinical application of NIRAF detection technology in protecting the parathyroid glands and the identification of fluorescent substances, both domestically and internationally, was conducted. ResultsThe majority of current studies indicate that NIRAF detection technology can effectively assist surgeons in identifying parathyroid tissue, improve the accuracy of intraoperative parathyroid identification, and reduce postoperative complications such as hypocalcemia. However, a small number of studies have found that the use of NIRAF detection technology during surgery does not significantly reduce postoperative complications in thyroid surgery patients, especially in those with secondary hyperparathyroidism. Current research on autofluorescent substances in the parathyroid glands remains relatively limited, with proteins such as the calcium-sensing receptor and vitamin D receptor being considered potential sources of fluorescence emitted by the parathyroid glands under near-infrared light excitation. ConclusionsBased on the reviewed literature, NIRAF detection technology for parathyroid gland identification has demonstrated significant effectiveness in intraoperative identification of parathyroid tissue and reduction of postoperative complications. However, limitations such as insufficient accuracy in patients with hyperparathyroidism and lack of user-friendliness restrict its clinical application. Therefore, future research should focus on identifying the endogenous fluorescent substances in the parathyroid glands and their luminescence mechanisms. This will enable targeted improvements in fluorescence detection technology, further enhancing the accuracy and convenience of intraoperative parathyroid detection, ultimately benefiting patients more significantly.