【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.
【Abstract】ObjectiveTo investigate the technique of establishing a model of aparathyroid rat which could be used in the study of parathyroid cells transplantation. Methods Parathyroid glands were surgically excised and identified pathologyically. Serum calcium and parathyroid hormone in rats before operation and on day 2，5，10，15 and 30 after operation were measured. Results Parathyroid glands were resected successfully in 8 rats, and the resection rate was 80% (8/10). No obvious changes of serum calcium and parathyroid hormone levels were found before and after operatiion in sham parathyroid gland excision group (Pgt;0.05). However, statistically significant changes of those data were found perioperatively in parathyroid gland excision group (P＜0.01). Conclusion The model of aparathyroid rat can be established successfully after parathyroid glands in rats are excised exactly. Parathyroid allotransplantation could be performed ten days after parathyriodectomy.
目的 探讨无功能性甲状旁腺囊肿（NFPTC）的诊断和治疗方法。方法 回顾性分析中国医科大学附属第一医院2008年3月至2012年10月期间手术治疗的6例NFPTC患者的临床资料。结果 6例患者中术前明确诊断3例；术后病理学检查证实均为甲状旁腺囊肿。术后无并发症发生；随诊7个月～5年，平均32个月，无复发。结论 NFPTC术前确诊困难，超声影像学特点对诊断有参考价值，手术切除是首选治疗方法。
Objective To introduce the advanced diagnostic technologies and share the surgical experience of parathyroid adenoma. Methods From November 1986 to August 2000, 9 patients with parathyroid adenoma who underwent operations were analyzed retrospectively. Out of them, there were 3 males and 6 females and their ages ranged from 12 to 55 years with an average of 32 years. The average disease course was 4 years and 9 months. General decreased density of the bone cortex and subperiosteum absorption were found in all 9 cases, while multi bone cyst lesion in 3 cases; obsolete fracture in 5 cases, in\cluding 2 cases of nephrolithiasis. Before operation, one child bore claudication and the other 8 patients suffered from disability. Serum parathyroid hormone (PTH) level increased markedly in 5 patients examined (633.87-1017.40 pmol/L, normal value: 28.50-90.50 pmol/L. Radionuclide scan showed tha imagings of parathyroid adenoma appeared in 4 patients. Results Parathryriod adenoma was resected via neek approach in 7 cases, and by way of sternum in the other 2 of the adnomas located in the chest, Parathyroid adenoma was diagnosed pathologically in 9 cases. All the 9 patients had no relapse during the 2-16 years of follow-up, with apparent relief of ostealgia and the normal serum PTH level, and roentgenogram showed fracture healing, great allevation of the osetopathia. Conclusion PTH examination as an advanced technique plays an important role in the differential diagnosis of hypercalcaemia. Color Dopperler and radionuclide scan can locate the lesion. It is vital to judge the nature of the lesion by naked eyes, while frozen slices serves as a necessity to confrrm. Enough parathyroid tissue should to be remained to assure normal parathyroid function. The variable number and ectopic possibility of parathyroid glands should be consiered. Both the short-term and long-term surgical outcome of parathyroid adenoma are satisfactory.
目的 探讨原发性甲状旁腺功能亢进症(PHPT)的诊治经验。 方法 回顾性分析我院近15年间18例手术治疗的PHPT患者的临床资料。结果 初诊病例术前核素99Tcm-sestamibi扫描和B超检查阳性定位诊断率分别为100%（9/9）和88%（15/17）。18例均经手术治疗，其中1例为再手术病例。术后病理诊断甲状旁腺腺瘤13例，其中1例为双腺瘤； 甲状旁腺增生4例； 甲状旁腺腺癌1例。首次手术治愈率为88%（15/17）。2例甲状旁腺增生病例未治愈。再手术1例因损伤了单侧喉返神经致术后声音嘶哑。结论 术前核素99Tcm-sestamibi扫描和B超检查对制定手术方案有重要意义，大多数PHPT病例适合行单侧颈部探查术。甲状旁腺增生病例的手术治愈率低。
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 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.
Parathyroid hormone (PTH) exerts multiple effects such as regulating bone remodeling, promoting angiogenesis, etc., and it is an active factor with great application potential for bone repair. In recent years, with the development of scaffold material loading strategies and parathyroid hormone-related peptides (PTHrPs), in situ loading of PTH or PTHrPs on scaffold materials to promote bone defect healing gradually becomes possible. Based on the current status and challenges of intermittent PTH (iPTH) for bone tissue engineering, the review summarizes the in-situ application strategies of PTH and the construction of PTHrPs as well as current problems and further directions in this field, with a view to propel the clinical application of scaffold materials loaded with PTH or PTHrPs in situ.
目的 探讨甲状旁腺腺瘤所致无症状原发性甲状旁腺功能亢进症（PHPT）的诊断和治疗。方法 回顾性分析中国医科大学附属第一医院1990年1月至2013年4月期间收治的24例甲状旁腺腺瘤所致无症状PHPT患者的临床资料。结果 24例甲状旁腺腺瘤所致无症状PHPT患者中男9例，女15例；年龄（47.92±12.96）岁。均无骨关节疼痛、病理性骨折、泌尿系结石或胃肠道症状等典型PHPT的临床表现，均为体检和并存或误诊为甲状腺疾病时发现。24例患者术前血钙升高18例，正常6例；血磷降低7例，正常17例；16例术前行血甲状旁腺激素检测患者中11例升高，正常5例；22例患者术前测定血碱性磷酸酶升高9例，正常13例。血钙与甲状旁腺激素均正常者4例，其中1例为体检时超声发现甲状旁腺病变，3例为手术治疗甲状腺疾病术中探查发现。24例患者术前均行超声检查，15例行甲状旁腺ECT检查，14例行甲状旁腺增强CT检查，阳性率分别为66.67% （16/24）、93.33% （14/15）及78.57% （11/14）。15例术前定性定位检查获得明确诊断，5例定性或定位检查高度怀疑甲状旁腺病变，4例术前误诊为甲状腺病变。均行甲状旁腺腺瘤切除，其中甲状旁腺腺瘤位于左侧上位2例、左侧下位9例、右侧上位2例、右侧下位11例。肿瘤最大径为（2.22±0.88） cm。24例患者中13例合并甲状腺病变。本组患者术后有8例出现手足、口周麻木，给予静脉或口服补钙后缓解，其余患者均无自觉症状。术后血钙及甲状旁腺激素均有不同程度下降，术后2周均降至正常范围。结论 甲状旁腺腺瘤所致无症状PHPT临床症状不典型，血清钙和甲状旁腺激素同步升高即可诊断，具有手术指征的患者应积极手术治疗。