| Objective:To study the effects of different type of parathyroid damage to the postoperative functional recovery of parathyroid,through establish an animal model by simulating total thyroidectomy and parathyroid damage during surgical operation.Methods:Experimental rabbits for the study were randomly divided into A, B, C, D four groups n=8,Group A (control group):simple exposure, exploration thyroid and parathyroid; group B(Vascular injury group):total thyroidectomy and ligation bilateral parathyroid blood supply but keep the surrounding membrane;Group C(Membrane damage group):total thyroidectomy and damage membrane but reservations blood supply.Group D (Composite damage group):total thyroidectomy plus membrane and blood both damage;All animals were monitored of serum calcium and PTH, preoperative Id and postoperative ld,3d,5d,7d;cut the parathyroid HE staining to observed survival of parathyroid tissue and pathology damage when 7d after operation.Results:1、Animals in each group preoperative serum calcium and PTH were no significant difference (P> 0.05);2、Group A postoperative serum calcium decreased,but at 5d returned to preoperative level(P>0.05);Group B and C postoperative 1,3,5 d serum calcium decreased significantly (P<0.05) and to the lowest at 1d and then gradually recovered,but group C faster recovered than group B (P<0.05); Group D postoperative ld,3d serum calcium continued to decline significantly (P<0.05);3、Group A postoperative serum PTH decreased,but at 7d returned to preoperative level(P>0.05);Group B and C postoperative 1,3,5 d serum PTH decreased significantly (P<0.05) and to the lowest at 1d and then gradually recovered,but from postoperative 3d group C faster recovered than group B (P<0.05); Group D postoperative ld,3d serum PTH continued to decline significantly (P<0.05);4\Pathology results:Group A Parathyroid filled with chief cells and a small amount of vacuolar changes (5%-10%);Group B Parathyroid hemorrhage, necrosis (40%-50%), part of the cell degeneration (30%-40%), center with fibrosis, seen granuloma and hyperplasia of parathyroid tissue in surrounding;Group C parathyroid bleeding (10%-20%), part of the cell degeneration (10%-20%);Group D parathyroid severe necrosis, almost no normal parathyroid tissue, significant fibrosis, less residual parathyroid tissue was scattered.Conclusions:1、The recover of Parathyroid function is influenced by the type of parathyroid in situ injury during thyroidectomy, composite damage of blood supply and membrane of parathyroid is the most serious, parathyroid ischemia necrosis, the function can not be restored,Pure blood supply damaged, some can restore function, and the parathyroid gland with vascular pedicle can be recovered quickly.2、for the severe blood supply and membrane damaged, and even free parathyroid should be transplanted immediately during operation.Objective:To study the effect of temporary in vitro preservation of parathyroid on the activity of cells in the process of parathyroid auto-transplantation and function of postoperative in order to improve the survival rate of transplantation.Methods:1、Experimental rabbits for the study were randomly divided into A, B, C three groups,n=8,Operate to remove the bilateral inferior parathyroid, A group (control group):parathyroid glands immediately formaldehyde-fixed;B group(old ischemia preservation group):the parathyroid glands were placed in 4℃ normal saline for 30 minutes and then fixed;C group(arm ischemia group):parathyroid glands were placed in room temperature (22-24 ℃) normal saline for 30 minutes and then fixed.HE staining was performed on the left parathyroid glands to observe the morphology of the cells;Electron microscopic examination of the right parathyroid glands were performed to observe the ultrastructural changes of the cells.2、Experimental rabbits were randomly divided into D, E, F three groups, n= 8, after total thyroidectomy, take out the double inferior parathyroid glands;D group:parathyroid glands were immediately transplanted in bilateral anterior cervical muscles;E group:glands were placed in 4 ℃ normal saline for 30 minutes and then transplanted into the anterior cervical muscles;F group:glands were placed in room temperature (22-24 ℃) normal saline for 30 minutes and then transplanted.3、All animals will be monitored of serum calcium and PTH, preoperative 1d and postoperative ld,3d,5d,7d;taking out the parathyroid for HE staining to observed survival of parathyroid tissue and pathology damage when 7d after operation.Results:1、A group:The normal parathyroid gland is mainly dominated by the chief cells with a small amount of eosinophils and surrounded by fat cells;Under electron microscope, the nucleus of the chief cell was round and centered;B group:there were no significant change in the morphology of parathyroid cells, and the mitochondria of the cells were slightly swollen;C group:the parathyroid gland cells were slightly swollen and partially vacuole degeneration,Under the electron microscope, the morphology of the nucleus was irregular, and the mitochondria were extremely swollen and deformed, and the ridge was broken.2、D, E, F three groups of rabbits after transplantation of parathyroid,Serum calcium and PTH decreased significantly, and increased gradually after the lowest in postoperative 1d;Among the three groups in preoperative and postoperative 1,3 and 5 d, calcium and PTH have no significant difference (P> 0.05), but 7d between the two groups had significant difference (P< 0.05);3、Postoperative 7d pathological results:D group:normal parathyroid cells densely distributed in the anterior cervical muscle tissue, E group:A large number of parathyroid cells surviving in muscle tissue,some vacuolated;F group:only part of healthy parathyroid cells scattered in the muscle.Conclusions:Time and temperature have effect on the temporary preservation of parathyroid, it should be transplanted immediately or preserved in 4 ℃ normal saline during the operation,and as far as possible in 30 minutes to complete the transplant in order to improve the survival rate of transplantation. |
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