Study on the Morphology and Function of a Single Parathyroid Gland in situ by Endoscopy and Parathyroid Hormone Determination in Drainage Fluid

Yun-hai MA; Jun QIAN; Shu-ling LI; Ting-ting YAN; Ruo-chuan Cheng

doi:10.12259/j.issn.2095-610X.S20211045

Volume 42 Issue 10

Oct. 2021

Turn off MathJax

Article Contents

Article Navigation > Journal of Kunming Medical University > 2021 > 42(10): 84-91

Yun-hai MA, Jun QIAN, Shu-ling LI, Ting-ting YAN, Ruo-chuan Cheng. Study on the Morphology and Function of a Single Parathyroid Gland in situ by Endoscopy and Parathyroid Hormone Determination in Drainage Fluid[J]. Journal of Kunming Medical University, 2021, 42(10): 84-91. doi: 10.12259/j.issn.2095-610X.S20211045

Citation:

Yun-hai MA, Jun QIAN, Shu-ling LI, Ting-ting YAN, Ruo-chuan Cheng. Study on the Morphology and Function of a Single Parathyroid Gland in situ by Endoscopy and Parathyroid Hormone Determination in Drainage Fluid[J]. Journal of Kunming Medical University, 2021, 42(10): 84-91. doi: 10.12259/j.issn.2095-610X.S20211045

Citation:

Yun-hai MA, Jun QIAN, Shu-ling LI, Ting-ting YAN, Ruo-chuan Cheng. Study on the Morphology and Function of a Single Parathyroid Gland in situ by Endoscopy and Parathyroid Hormone Determination in Drainage Fluid[J]. Journal of Kunming Medical University, 2021, 42(10): 84-91. doi: 10.12259/j.issn.2095-610X.S20211045

PDF( 740 KB)

Study on the Morphology and Function of a Single Parathyroid Gland in situ by Endoscopy and Parathyroid Hormone Determination in Drainage Fluid

doi: 10.12259/j.issn.2095-610X.S20211045

1.
Thyroid Surgery Center
2.
Otolaryngological Department of the First Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China

Received Date: 2021-08-06
Available Online: 2021-11-12
Publish Date: 2021-10-30

Abstract

Abstract

Objective To explore the changing rule of morphology and function single parathyroid gland in situ, so as to provide a theoretical basis for the survival, function and prognosis of parathyroid glands with different blood supply types. Methods Forty-two patients who underwent unilateral thyroidectomy, single parathyroid gland transplantation and retained the other parathyroid gland in situ due to the type of blood supply, were selected as objects. Target parathyroid glands were dynamically observded by nasal endoscope with inner diameter of 0.5 cm connected to previously retained drainage tube at different intervals of postoperation. The drainage liquid was collected to detect the level of dPTH in following 1st, 2nd, 3rd day between 7 and 8 am. Above patients were divided into three groups for pairwise comparison. The first group: glands shown ≤50% and＞50% in naked area, the second group: vascular pedicle could be observed in parathyroid glands in situ by naked eye, the third group: the superior parathyroid gland and the inferior parathyroid gland. SPSS17.0 was used for statistical analysis. Results Twenty-six target parathyroid glands were observed by endoscope at different intervals of postoperation, 19 of which were superior parathyroid glands and the rest were inferior parathyroid glands. 18 parathyroid glands were found and recorded while 3 superior parathyroid glands were found by endoscope at 24 h of postoperation. 19 parathyroid glands were found , recorded while 4 superior parathyroid glands were not found at 48 h of postoperation. During operation, 14 of 15 superior parathyroid glands almost completely retained blood supply and contected with visible vascular pedicle, the rest 1 had no obvious vascular pedicle and exhibited black at both 24 h and 48 h of postoperation, being considered as necrosis while other superior parathyroid glands had no symptom of necrosis. The naked area of 7 inferior parathyroid glands in situ ranged from 50.0% to 95.0%, 2 of which exhibited visiable vascular pedicle while the rest 5 did not and fibrous membranes contected to periphery were observed in 4 of 5 inferior parathyroid glands. Extravasated blood was obvious in 2 inferior parathyroid glands in situ and the rest 5 was normal in clolor during operation. As for the rest 5 normal inferior parathyroid glands, 2 exhibited ecru for slight extravasated blood, 1 displayed yellowish-white for ischemia, and the rest 2 were normal at 24 h postoperation. 2 inferior parathyroid glands with slight bleeding shown reddish brown, 5 were normal in color and 1 with ischemia exhibited yellowish-white. Experimental data results of statistical analysis: （1） The difference of dPTH of different intervals on the basis of different naked area pairwise comparison was statistically significant （P < 0.05）. The larger naked area of parathyroid glands remained in situ during operation induced more serious destruction on blood supply, yielding to more profound influence on function of glands. （2） The difference of dPTH of different intervals on the basis of pairwise comparison between the presence and absence of vascular pedicles was not statistically significant （P > 0.05）. However, significance existed between two groups only in term of experimental data of dPTH at different intervals of postoperation. The count of dPTH from the presence of vascular pedicles was more high that of dPTH without vascular pedicles but no statistical difference was found, perhaps sample size could account for divergence. （3） The difference of dPTH of different intervals on the basis of pairwise comparison between superior and inferior parathyroid gland was statistically significant （P < 0.05）. It is further confirmed that compared with inferior parathyroid gland, superior parathyroid gland was more trend in situ because of less in naked area, blood supply and more integrity of peripheral vessels and connective tissue. Conclusions The recent morphology and function of single parathyroid gland preserved in situ can be studied through endoscopic observation and monitoring of the level and changing rule of dPTH after thyroid surgery . The maintenance of dPTH at a high level after operation is a direct evidence of the survival of parathyroid glands preserved in situ.The high postoperative dPTH shows that in most cases, the operation only affects the way of PTH secretion into the blood and the parathyroid gland retained in situ can still secrete a large amount of PTH. The decrease of dPTH to a low level 24 hours after operation shows that the parathyroid gland retained in situ has serious damage, obvious blood supply destroy and depressed secretion.
- Thyroid surgery,
- Endoscope,
- Drainage fluid parathyroid,
- Parathyroid glands

FullText(HTML)

References(18)

References

[1]	马云海,钱军,程若川,等. 监测甲状腺术后引流液和血清中甲状旁腺素及血钙的临床意义[J]. 中华内分泌外科杂志,2014,8(4):301-305. doi: 10.3760/cma.j.issn.1674-6090.2014.04.013
[2]	黄韬. 甲状旁腺术中损伤的预防和处理[J]. 中国实用外科杂志,2008,28(3):179-180. doi: 10.3321/j.issn:1005-2208.2008.03.009
[3]	程若川,艾杨卿,刁畅,等. 甲状腺手术中甲状旁腺显露及功能保护的临床研究[J]. 中国普外基础与临床杂志,2009,16(5):351-355.
[4]	Lee D Y,Cha W,Jeong W J,et al. Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia[J]. Laryngoscope,2014,124(5):1272-1277. doi: 10.1002/lary.24519
[5]	Bliss R D,Gauger P G,Delbridge L W. Surgon's approach to the thyroid gland:surgical anatomy and the importance of technique[J]. World J Surg,2000,24(8):891-897. doi: 10.1007/s002680010173
[6]	陈杨,李文杰,林乐岷. 被膜解剖技术用于甲状腺全切除术[J]. 中国临床医学,2011,18(5):708-710. doi: 10.3969/j.issn.1008-6358.2011.05.049
[7]	朱精强,汪洵理,魏涛,等. 纳米碳甲状旁腺负显影辨认保护技术在甲状腺癌手术中的应用[J]. 中国普外基础与临床杂志,2013,20(9):992-994.
[8]	Thomusch O,Machens A,Sekulla C,et al. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery:a multivariate analysis of 5846 consecutive patients[J]. Surgery,2003,133(2):180-185. doi: 10.1067/msy.2003.61
[9]	Cavicchi O,Piccin O,Caliceti U,et al. Accuracy of PTH assay and corrected calcium in early prediction of hypoparathyroidism after thyroid surgery[J]. Otolaryngol Head Neck Surg,2008,138(5):594-600. doi: 10.1016/j.otohns.2008.01.016
[10]	Khairy G A,Al-Saif A. Incidental parathyroidectomy during thyroid resection:incidence,risk factors,and outcome[J]. Ann Saudi Med,2011,31(3):274-278. doi: 10.4103/0256-4947.81545
[11]	Shaha A R. Revision thyroid surgery-technical considerations[J]. Otolaryngol Clin North Am,2008,41(6):1169-1183.
[12]	Sywak M S,palazzo F F,Yeh M,et al. parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy[J]. ANZ J surg,2007,77(8):667-670. doi: 10.1111/j.1445-2197.2007.04183.x
[13]	Warren F M,Andersen P E,Wax M K,et al. Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery[J]. Laryngosecope,2002,112(10):1866-1870. doi: 10.1097/00005537-200210000-00031
[14]	闫利英,赵瑞敏,施秉银. 甲状腺术中快速甲状旁腺素测定对预测术后低钙学症发生危险性的研究进展[J]. 中华耳鼻喉头颈外科杂志,2006,46(6):474-476.
[15]	周广起,刘新梅,熊斌,等. 分化型甲状腺癌术后PTH变化及发生低钙血症的临床分析[J]. 中国普通外科杂志,2014,23(5):700-702.
[16]	Graciano A J,Chone C T,Fischer C A. Applicability of immediate,late or serial intact parathyroid hormone measurement following total thyroidectomy[J]. Braz J Otorhinolaryngol,2012,78(5):78-82. doi: 10.5935/1808-8694.20120012
[17]	Pisanu A,Saba A,Coghe F,et al. Early prediction of hypocal-cemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement[J]. Langenbecks Arch Surg,2013,398(3):423-430. doi: 10.1007/s00423-012-1017-6
[18]	Costanzo M,Marziani A,Condorelli F,et al. Post-thyroidectomy hypocalcemic syndrome:predictive value of early PTH. Preliminary results[J]. Ann Ital Chir,2010,81(4):301-305.

Relative Articles(20)

Relative Articles

[1]	Wei WANG, Ruimei SUN. Advances in Endoscopic Thyroid Surgery. Journal of Kunming Medical University, 2024, 45(4): 184-191. doi: 10.12259/j.issn.2095-610X.S20240427
[2]	Qingxia YANG, Changrong WU, Juanzhang LUO, Wei WANG, Yahong WANG, Ruimei SUN. Clinical Data Analysis of 108 Patients with Primary Hyperparathyroidism. Journal of Kunming Medical University, 2023, 44(4): 75-81. doi: 10.12259/j.issn.2095-610X.S20230411
[3]	Wei WANG, Qingxia YANG, Juanzhang LUO, Yahong WANG, Fuke WANG, Ruimei SUN. Efficacy of Transaxillary Approach Endoscopic Thyroid Surgery for the Treatment of Single-Sided Thyroid Cancer. Journal of Kunming Medical University, 2023, 44(12): 65-71. doi: 10.12259/j.issn.2095-610X.S20231211
[4]	Wanyou JIA, Hongli LIU, Weiwei JIANG, Hongmin LI, Shuo ZHANG, Jimin FEI. Risk Factors for Hypoparathyroidism after Thyroidectomy. Journal of Kunming Medical University, 2022, 43(9): 84-89. doi: 10.12259/j.issn.2095-610X.S20220904
[5]	Hangcheng TIAN, Ruochuan CHENG, Yingsheng BAO, Yuhua ZHANG, Jun HAN, Hongmei KUANG, Changwei ZHOU. Influence of Different Thyroid Surgery Methods on the Function of Parathyroid Glands. Journal of Kunming Medical University, 2022, 43(7): 92-96. doi: 10.12259/j.issn.2095-610X.S20220719
[6]	Yuan Hu Ying , Zhou Qing , Zeng Ya Ya , Wan Hui Min , Jin Xiao Yan . Application of Nurse-Physician Collaboration in the Perioperative Period of Ocular Endoscope-Assisted Vitrectomy among Patients with Ocular Trauma. Journal of Kunming Medical University, 2018, 39(07): 141-145.
[7]	Li Si Qi , Wu Tao , Li Yan , Zhang Yi , Zhao Zhi Jing , Dong Li Ying , Liang Ying , Mao Ying , Ma Jun Feng . . Journal of Kunming Medical University, 2017, 38(02): 109-113.
[8]	Li Lei , Yang Jie , Wang Wei Lin , Wang Hu . Surgical Treatment Strategy of Thyroid Carcinoma with Hashimoto's Thyroiditis. Journal of Kunming Medical University, 2017, 38(10): 95-100.
[9]	Zhang Hong , Fang Xing Bao , Xu Bin Yong , Wang Zhao Xiong , Ge Jia Yun . Application of Carbon Nano Negative Parathyroid Imaging in Thyroid Cancer Surgery. Journal of Kunming Medical University, 2017, 38(11): 58-61.
[10]	Guo Yue Cheng . The Strategy of Percutaneous Endoscopic Lumbar Discectomy for Treating 4/5 Lumbar Intervertebral Disc Herniation. Journal of Kunming Medical University,
[11]	Zhao Gong Fang . . Journal of Kunming Medical University,
[12]	Sun Rui Mei . . Journal of Kunming Medical University,
[13]	Yuan Hong Mou . . Journal of Kunming Medical University,
[14]	Gong Jian Yu . . Journal of Kunming Medical University,
[15]	Yang Hui . . Journal of Kunming Medical University,
[16]	Yang Hui . . Journal of Kunming Medical University,
[17]	Liu Zhan Quan . . Journal of Kunming Medical University,
[18]	. Treatment of Perennial Allergic Rhinitis by Electrocautery under the Nasal Endoscope. Journal of Kunming Medical University,
[19]	. . Journal of Kunming Medical University,
[20]	. Parathyroid Glands Can Be Easily ldentified and Preserved by Activated Carbon Particles in Surgery of Thyroid Carcinoma. Journal of Kunming Medical University,