甲状旁腺移植

近年国内外有许多关于临床或实验甲状旁腺自体移植,同种异体移植(以下简称异体移植),甚至异种移植的报道。甲状旁腺移植给外科医生在处理甲状旁腺疾患时提供了一种可供选择的治疗方案。移植方法【自体移植】1.操作:普遍都采用 Wells 介绍的方法。甲状旁腺组织被切下后,马上置于4℃生理盐水或其他培养基中,培养基放置在盛满碎冰的容器中。然后把腺     

甲状旁腺瘤组织同种移植治疗甲状旁腺功能低下症初步报告

目的　为甲状旁腺移植的供体来源提供一种新途径。　方法　将甲状旁腺瘤组织用 6Gy60 钴照射后 ,切成 0 5mm× 0 5mm× 0 5mm～ 1 0mm× 1 0mm× 1 0mm薄片 ,植入裸鼠肾包膜下过渡 14d ,移植给甲状旁腺功能低下症患者 ,受者术前 1d及术后 14d服用环孢素A(5mg·kg 1·d 1) ,以后不用任何免疫抑制剂。术后观察临床症状、体征、治疗的钙剂及罗钙全剂量变化 ,检测血钙及血甲状旁腺激素 ,以确定移植效果。　结果　临床应用 5例 ,其中 3例术后不需静脉补钙 ,口服钙剂量及罗钙全剂量减少 ,血钙浓度基本恢复到正常值。　结论　甲状旁腺瘤组织为甲状旁腺移植提供了一种方便、易于获取的新的供体 ,且可移植给多个患者治疗。     

甲状旁腺移植研究新进展

甲状旁腺移植是甲状旁腺功能低下 (hy poparathyroidism)患者获得生理性血钙水平的理想途径 ,由Halsted于 190 7年首先报道。在移植方式上 ,目前的临床和实验研究趋向于创伤小、操作简便、可反复进行的细胞和组织移植并取得了一定的进展 ,移植前后对甲状旁腺及受体的处理方法也有了很大程度的改进 ,但也存在一些实际的问题亟待解决。现将近年来的研究情况总结并报告如下。一、甲状腺手术对甲状旁腺功能的影响甲状腺全切术或保留峡部的双侧甲状腺叶切除术对术后甲状旁腺功能有显著影响。Meyer等[1] 对 30 8例甲状腺手术患者 (116例双侧腺叶…     

策略性甲状旁腺自体移植在甲状腺乳头状癌再次中央区淋巴结清扫中的应用

目的探讨策略性甲状旁腺自体移植是否能有效减少甲状腺乳头状癌(PTC)再次中央区淋巴结清扫术后甲状旁腺功能低下的发生率。方法回顾性分析2009年1月至2015年10月期间在四川大学华西医院甲状腺外科因PTC复发(淋巴结转移)再次行单侧或双侧中央区淋巴结清扫(包括颈侧区清扫)患者的临床资料,根据初次手术是否行策略性甲状旁腺自体移植分为移植组和未移植组。统计及比较2组患者一般情况、术前血Ca2+及甲状旁腺激素水平、首次手术方式、再次手术前是否存在声带麻痹、再次手术方式和术后并发症。结果 74例PTC再次手术患者纳入研究,其中移植组35例,未移植组39例。术后1 d血Ca2+及甲状旁腺激素水平移植组明显高于未移植组(P0.05);移植组2例患者新出现喉返神经损伤,未移植组5例新出现喉返神经损伤(5.7%比12.8%,P0.05);移植组和未移植组分别有4例和12例出现暂时性甲状旁腺功能低下,1例和4例出现永久性甲状旁腺功能低下,2组甲状旁腺功能低下发生率差异有统计学意义(14.3%比41.0%,P0.05)。术后病理学检查结果提示2组中央区淋巴结清扫数目分别为(2.1±1.3)枚和(1.4±0.7枚),其差异有统计学意义(P0.05)。结论策略性甲状旁腺自体移植可有效减少PTC再次中央区淋巴结清扫术后甲状旁腺功能低下的发生,从而大大提高手术安全性及彻底性。     

头颈部外科

甲状旁腺移植的近况 [Wells S A:Jr.Surg.Clin.North Am.59:167,1979.] 本文复习了一组将甲状旁腺组织移植到肌肉的75例病人,描述了手术操作以及甲状腺组织的冷冻保存方法。在甲状旁腺亢进引起的肾性骨营养不良,做全甲状旁腺切除,同时将自体甲状旁腺组织异位移植于前臂肌肉。缝线永久存留,作为标记,如需再行切除甲状旁腺组织,则甚至在局麻下也容易进行。这一方法也可用于原发甲状旁腺增生,以及甲状腺全切除时必须切除甲状旁腺或甲状旁腺的血供已受损的病例。由引流甲状旁腺移植体的肘前静脉取血,     

尿毒症继发甲状旁腺功能亢进的特点及外科治疗

继发性甲状旁腺功能亢进（SHPT）是慢性肾功能衰竭的重要并发症,SHPT患者甲状旁腺呈非对称性增大并伴有结节形成,甲状旁腺组织中Ca^2＋敏感受体基因、维生素D受体基因有异常表达.SHPT可致患者出现骨痛、骨骼畸形、甲状旁腺激素和碱性磷酸酶水平增高、骨纤维囊性变、弥漫性脱钙等表现,严重者可出现胸骨畸形、压缩性骨折、心脏瓣膜钙化等。对于存在甲状旁腺激素显著增高、甲状旁腺增大、纤维性骨炎或高度骨代谢运转以及内科治疗无效等情况者杠般建议行外科治疗。甲状旁腺全切前臂自体移植对晚期肾性SHPT是非常有效的治疗方法。手术的关键是要切除所有的甲状旁腺,使用质地柔软的弥漫性增生的组织进行移植。切除的甲状旁腺数一般为2-4枚,若有多余腺体,应在初次手术时切除。术后应进行钙替代治疗。甲状旁腺切除前臂自体移植可显著改善SHPT患者的临床症状和生化参数。持续性和复发性HPT的发生率一般为0-10％。持续性HPT的主要原因为纵隔甲状旁腺,复发的原因常为前臂自体移植物增生、多余腺体、剩余增生腺体、周围组织中旁腺组织的种植、旁腺癌的转移等。为防止术后发生持续性或复发性HPT．在初次手术时要切除所有的腺体以及胸腺舌,手术后应定期随访。根据患者血甲状旁腺激素水平、核素及影像学检查可诊断移植物依赖性复发。     

腔镜甲状腺术中识别与保护甲状旁腺的研究进展

随着人们生活质量的提高，腔镜甲状腺切除术逐渐成为治疗甲状腺疾病的主要术式。甲状旁腺功能减退是术后常见并发症之一，因此术中对甲状旁腺的识别与保护仍是临床医生关注的重点。目前临床已有精细被膜解剖技术、显影技术、组织学检测、甲状旁腺自体移植等技术对甲状旁腺进行识别与保护。本文现结合国内外相关文献，就腔镜甲状腺手术中甲状旁腺的识别与保护的研究进展作一综述。     

异体甲状旁腺脑室内移植治疗甲状旁腺机能减退症

应用异体甲状旁腺进行脑室内移植治疗甲状旁腺机能减退症６例，疗效满意，术后临床症状消失或明显减轻，连续监测血清钙、血清磷和尿钙、尿磷均证实移植物在脑室内存活并有正常的生理功能。随访７－２２个月病情均无复发。本文对脑室内组织移植的手术方法，胎儿甲状旁腺的取材及术后可能发生的并发症进行了讨论。     

异体肌腱移植的研究方向与现状

肌腱损伤是手部常见损伤，肌腱缺损约占肌腱损伤的25％。自体肌腱移植的方法尚不能满足临床的需要，虽然人工腱的研制与组织工程腱的研究有了长足的进展，但在临床应用上尚存在一些问题。自上世纪80年代起，异体肌腱移植的相关研究渐被人们所重视。异体肌腱的优点有：来源充足、取材方便、手术时间短、减少患者新的损伤，及供区的功能影响。国内外学者对异体肌腱的获取、保存、处理，临床应用和预后方面做了大量的研究工作，以使异体肌腱移植技术日臻完善。为我们临床工作中肌腱移植提供了理论支持与应用经验。     

继发性甲状旁腺功能亢进围手术期多学科综合诊治华西共识

为规范继发性甲状旁腺功能亢进治疗，切实满足实际临床工作的需要，我们召集四川大学华西医院甲状腺外科、肾脏内科、内分泌代谢科、核医学科、超声科、麻醉科、心脏内科等科室专家和护理专家，广泛征求意见，以国内外已发表的指南和中英文最佳证据为依据，并结合临床实践，最终制定本共识。本共识旨在最大程度对继发性甲状旁腺功能亢进围手术期诊疗可能遇到的实际问题进行总结和归纳，并提供临床实践建议。     

Simultaneous Kidney-Parathyroid Allotransplantation From a Single Donor After 20 Years of Tetany: A Case Report

Persistent hypocalcemia after total parathyroidectomy and autotransplantation is rare and occasionally has been treated using allotransplantation of parathyroid tissue. We present the case of a 32-year-old woman with terminal renal failure who at age 5 years underwent a first renal transplantation from a brain-dead donor. The graft was lost as a result of acute rejection. Tertiary hypoparathyroidism developed, which was treated with total parathyroidectomy and implantation in the forearm of a standardized amount of parathyroid tissue. The graft failed, and hypoparathyroidism developed. Despite a second implantation of cryopreserved autologous tissue, severe hypocalcemia persisted with a tendency for tetany. Although the patient was highly dependent on high-dose vitamin D₃ (tacalcitol) and calcium supplements, regular paresthesias and tetany developed. At age 9 years, the patient underwent a second renal transplant from a living related donor (her mother). After 18 years, the graft was lost as a result of chronic cyclosporine toxicity and angiosclerosis. Four years later, the patient underwent combined kidney and parathyroid transplantation from a local brain-dead donor. Preservation of the parathyroid glands was in University of Wisconsin solution, with cold ischemia time of 14 hours. Directly after the renal transplantation, parathyroid transplantation was performed, with implantation in the forearm of the total amount of donor parathyroid tissue. Postoperatively, there was recovery of parathyroid function, and the patient was able to discontinue vitamin D and calcium supplements after more than 20 years.     

Correction of both immunodeficiency and hypoparathyroidism by thymus transplantation in complete DiGeorge syndrome

Combined immune deficiency due to athymia in patients with complete DiGeorge syndrome can be corrected by allogeneic thymus transplantation. Hypoparathyroidism is a frequent concomitant clinical problem in these patients, which persists after thymus transplantation. Cotransplantation of allogeneic thymus and parental parathyroid tissue has been attempted but does not achieve durable correction of the patients' hypoparathyroidism due to parathyroid graft rejection. Surprisingly, we observed correction of hypoparathyroidism in one patient after thymus transplantation. Immunohistochemical analysis and fluorescence in situ hybridization confirmed the presence of allogeneic parathyroid tissue in the patient's thymus transplant biopsy. Despite a lack of HLA‐matching between thymus donor and recipient, the reconstituted immune system displays tolerance toward the thymus donor. Therefore we expect this patient's hypoparathyroidism to be permanently cured. It is recognised that ectopic parathyroid tissue is not infrequently found in the thymus. If such thymuses could be identified, we propose that their use would offer a compelling approach to achieving lasting correction of both immunodeficiency and hypoparathyroidism.     

Parathyroid transplantation: fate of a long-term allograft in man.

Previously our group reported clinical, histological, and biochemical evidence of parathyroid allograft survival in a patient transplanted sequentially with renal and parathyroid tissues from the same donor. After 30 months of function, both grafts were concomitantly rrjected. The prolonged parathyroid allograft survival described in certain experimental animals has been attributed to the tissue's being "immunologically privileged." Our current clinical observations do not support this hypothesis.     

Influence of donor MHC class I antigen expression on graft survival after rat parathyroid allotransplantation

BACKGROUND AND AIMS: We investigated the influence of donor MHC antigen expression on graft survival after parathyroid transplantation in three different strain combinations. METHODS: MHC class I and II expression on parathyroid tissue of Lewis (LEW), Dark Agouti (DA), and Wistar-Furth (WF) rats was first analysed semiquantitatively by immunohistochemistry. Additionally, five groups were transplanted: (1) LEW to LEW, (2) DA to DA, (3) LEW to DA, (4) WF to LEW, and (5) DA to LEW. METHODS: MHC class I expression was strong in DA, moderate in WF, and weak in LEW rats; MHC class II expression was negative in all three strains. In the interstitium of all investigated tissue specimens, the proportion of MHC class II-expressing cells was low. RESULTS: After syngeneic transplantation, graft survival could be documented over the whole observation period. A mean graft survival of 20 (+/-2) days was observed following transplantation from LEW to DA, grafts in the group WF to LEW were rejected after 13 (+/-1) days, and graft function lasted 8 (+/-2) days in the group DA to LEW. The number of intragraft leukocytes expressing MHC class II molecules was equal in all groups, whereas increased levels of MHC class I on rat parathyroid tissue before transplantation resulted in a more rapid rejection. CONCLUSION: These results demonstrate that immunogenicity of rat parathyroid tissue seems to be determined by the amount of MHC class I expressed on donor parenchymal cells.     

Therapeutic cloning applications for organ transplantation

A severe shortage of donor organs available for transplantation in the United States leaves patients suffering from diseased and injured organs with few treatment options. Scientists in the field of tissue engineering apply the principles of cell transplantation, material science, and engineering to construct biological substitutes that will restore and maintain normal function in diseased and injured tissues. Therapeutic cloning, where the nucleus from a donor cell is transferred into an enucleated oocyte in order to extract pluripotent embryonic stem cells, offers a potentially limitless source of cells for tissue engineering applications. The present chapter reviews recent advances that have occurred in therapeutic cloning and tissue engineering and describes applications of these new technologies that may offer novel therapies for patients with end-stage organ failure.     

Rat parathyroid allotransplantation: Influence of MHC antigen expression on graft survival

MHC antigen expression in parathyroid tissue and its influence on graft survival after allogeneic transplantation were investigated using a heterotopic rat transplantation model. MHC class I and II expression in parathyroid tissue of Lewis (LEW), Dark Agouti (DA), and Wistar-Furth (WF) rats was analysed semi-quantitatively by using immunohistochemistry. MHC class I expression was strong in DA, moderate in WF, and weak in LEW rats parenchyma, whereas MHC class II expression was negative. In the interstitium of all investigated tissue specimens, the proportion of MHC class II-expressing cells was low. Additionally, four groups were transplanted: 1) LEW to LEW, 2) DA to DA, 3) LEW to DA, and 4) WF to LEW. After syngeneic transplantation, graft survival could be documented over the whole observation period. A median graft survival of 20 (+/-2) days was observed after transplantation from LEW to DA, whereas grafts in the group WF to LEW were rejected after 13 (+/-1) days. The number of intra-graft leucocytes expressing MHC class II molecules was the same in all groups, whereas increased levels of MHC class I in parathyroid tissue before transplantation resulted in a more rapid rejection. These results indicate that immunogenicity of rat parathyroid tissue might be determined by the amount of MHC class I expressed in donor parenchymal cells. Further experiments are necessary to validate this observation.     

Hair Transplantation: Management of Donor Area

BACKGROUND: Hair transplantation entails the removing of a strip of permanent hair from the occipital scalp and reimplanting it piecemeal into the recipient area. Methodologies for effecting this are reasonably complex and have undergone many changes and improvements over the years. The simplest part of hair transplantation, at least in theory, is the removal of the donor strip and closure of the resultant defect. Unfortunately, however, the improvements that have taken place in hair transplantation in general have not spilled over into improved donor area outcomes. Unsightly donor scars and fibrosis are still not only with us, but are possibly even more pervasive than ever. One explanation given for deteriorated donor sites is the harvesting of relatively greater numbers of grafts. But is this the whole story? OBJECTIVE: To describe some technical aspects of donor area management consistent with harvesting the best possible donor strip, while leaving an inconspicuous scar and preserving the viability of the residual tissues for subsequent harvesting. METHODS: In 1994 a clinical research project designed to determine what technical surgical modalities are optimal for excising and reconstructing scalp tissues was commenced. This was done with particular reference to the donor area in hair transplantation. The study involved more than 1000 scalp operations using various techniques and instrumentation, and comparing and contrasting results. RESULTS: The best results were obtained when tissues were least traumatized. Tension generated at wound closure was found to be the main culprit in determining less than optimal residual donor sites. CONCLUSION: Notably improved postharvesting donor sites are most likely to result when measures are taken to ensure minimal trauma by taking definitive steps to combat tension in the tissues. Modest undermining combined with deep plane fixation facilitates channeling of tension vector forces from at-risk superficial tissues into nonundermined tissues and deep tissues, each of which is optimally equipped to withstand the adverse consequences of tension.     

Transplant coordination activities in the Başkent University Hospital Network

Our transplantation center adopted a new model of operation, with 3 affiliated centers of the Ba?kent University. The aim of this system is to standardize procedures related to organ procurement and transplantation, to increase organ donation, and to improve the quality of services. The transplant team is composed of a transplant coordinator, and transplant clinicians and surgeons. The transplant coordinator works independently, and promotes organ donation and procurement, organizes interviews with donor families, and is in contact with national and international organ-sharing organizations. The organs and tissues are transplanted in the Ankara hospital of the network if the cadaver organ source is one of the Ba?kent University hospitals. If no appropriate recipient is available, the organs and tissues are offered to the National Coordination Center for other transplantation centers. To implement this system most efficiently and effectively, periodic situation analyses were made.     

Familial Hypocalciuric Hypercalcemia in the Donor and Recipient of a Living Related Donor Kidney Transplant

Familial hypocalciuric hypercalcemia (FHH) is caused by heterozygous inactivation of the calcium-sensing receptor, which is notably expressed in parathyroid and kidney. FHH is characterized by asymptomatic hypercalcemia and hypophosphatemia and confers minimal, if any, morbidity. Renal transplantation in patients with FHH has not been described previously. This report describes a patient with FHH who developed end-stage renal disease from another cause and subsequently received a living related donor kidney transplant from her FHH-affected daughter. The excellent posttransplant clinical course of both recipient and donor is emphasized.     

Fatal transfer of malignant melanoma from multiorgan donor to four allograft recipients

BACKGROUND: In this report we describe the transfer of malignant melanoma from a single donor to four solid organ transplant recipients, all of whom died from metastatic melanoma. METHODS AND CASE HISTORIES: The donor of a heart, liver, and two kidneys to four separate recipients died of intracerebral hemorrhage. The donor had no history or clinical evidence of melanoma. All four recipients, treated with standard immunosuppression protocols, developed metastatic malignant melanoma within 1 year after transplantation Three patients died within 14 months after transplantation, although the fourth, whose immunosuppressive therapy was discontinued, died of metastatic melanoma 30 months after renal transplantation. FINDINGS: Tumors from all recipients were histologically identical. Donor origin of tumor cells was confirmed by polymerase chain reaction (PCR)-based DNA analysis for polymorphic short tandem tetrameric repeats (Geneprint STR, Promega Corp., Madison, WI). DNAs from nontumorous donor tissue and tumor tissue available from three recipients tested positive for CSF1P0 alleles 10 and 12 and for TH01 alleles 6 and 7, although DNAs from nonneoplastic recipient tissues all exhibited different allelotypes. INTERPRETATION: Transmission of fatal or potentially fatal malignant tumors, notably malignant melanoma, from donor to recipient is an uncommon complication of solid organ transplantation. PCR-based genetic analysis permits definitive assignment of the source of posttransplant tumors.