Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience

Autor: Silvia Ministrini, Silvia Lai, Nazario Portolani, Claudio Casella, Mira Dimko, Luigi Totaro, Alessandro Galani
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Parathyroidectomy
medicine.medical_specialty
Article Subject
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Anterior compartment of the forearm
030232 urology & nephrology
Endocrinology
Endocrine and Autonomic Systems
lcsh:Diseases of the endocrine glands. Clinical endocrinology
03 medical and health sciences
Hyperphosphatemia
0302 clinical medicine
Forearm
medicine
Secondary Hyperparathyroidism
Hyperparathyroidism
lcsh:RC648-665
business.industry
medicine.disease
Autotransplantation
Surgery
Diabetes and Metabolism
Parathyroidectomy
Secondary Hyperparathyroidism
subcutaneous forearm autotransplantation
medicine.anatomical_structure
Hypoparathyroidism
030220 oncology & carcinogenesis
Clinical Study
Secondary hyperparathyroidism
subcutaneous forearm autotransplantation
business
Zdroj: International Journal of Endocrinology, Vol 2018 (2018)
International Journal of Endocrinology
ISSN: 1687-8345
1687-8337
Popis: Introduction. Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation. Materials and Methods. A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat. Results. A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group (p=0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism (p=0.387). 2 patients showed persistent hyperparathyroidism (p=0.816), and in 2 others was found recurrent hyperparathyroidism (p=0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit. Conclusions. The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice.
Databáze: OpenAIRE
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