188宝金博页面版

123O ncOlOgyParathyroid function study in patients submitted to laryngeal surgery for squamous cell carcinomaStudio della funzione paratiroidea in pazienti sottoposti a chirurgia laringea per carcimoni squamocellulariM. GeMiniani, C. aiMoni, G. SCanelli 1 , a. PaStoreent Clinic, 1 Clinical internal Medicine, University Hospital of Ferrara, italySUMMARYAim of this study was to investigate any eventual quantitative variations in the serological concentration of parathormone in a homogenous sample of patients suffering from laryngeal squamous cell carcinoma who underwent only surgery. A total of 12 patients (2 female, 10 male), aged between 58 and 76 years, were treated between June 2002 and June 2003. The patients were all affected by T2-T3 laryngeal squamous cell carcinoma. Serum intact parathyroid hormone and calcaemia were measured pre- and post-operatively. Of these patients, 2 underwent total laryngectomy (including thyroid isthmectomy), 5 patients re-ceived partial supraglottic laryngectomy, while the remaining 5 were submitted to supracricoid laryngectomy. Results showed a progressive regression of parathyroid hormone level, in only one case and was not, however, below normal limits. Contrary to data reported in the literature, this study indicated that the incidence of hypoparathyroidism following laryngeal surgery, even in radical surgical approaches, proved to be closer to zero.KEY WORDS: Parathyroid hormone, Squamous Cell Carcinoma, Larynx, Laryngeal surgeryRiASSUnTOQuesto studio si propone di ricercare variazioni quantitative della concentrazione sierologica di paratormone in un campione omogeneo di pazienti affetti da neoplasia squamocellulare laringea sottoposti a trattamento chirurgico elettivo ed esclusivo. 12 pazienti (2 donne, 10 uomini) di età compresa fra 58 e 76 anni, sono stati trattati dal giugno 2002 al giugno 2003. Tutti i pazienti, affetti da neoplasie squamocellulari maligne in stadio T2 o T3, sono stati sottoposti ad un follow-up comprendente dosaggio sierico di paratormone intatto e calcemia, dopo 3, 6, 12 mesi dall’intervento chirurgico. Di questi pazienti 2 sono stati sottoposti a laringectomia totale (comprendente istmectomia tiroidea), 5 a laringectomia sub-totale sopraglottica e 5 a laringectomia sopracricoidea. In un solo caso si è riscontrata una diminuzione progressiva della paratormonemia, pur non al di sotto dei limiti di norma. A differenza di quanto riportato in letteratura, l’incidenza di ipoparatiroidismo post chirurgia laringea, pur comprendendo approcci chirurgici più o meno demolitivi, è parsa essere prossima allo zero.PAROLE CHiAVE: Paratormone, Carcinoma squamocellulare, Laringe, Chirurgia laringeaIntroductionin laryngeal surgery, dissection or closure of the vascular pe-duncles of the thyroid 1 , is performed, the common embryo-logical origin of the parathyroid and thyroid glands being ref l ected in the same vascular anatomy. The close anatomic relationship of these glands with the laryngeal structures ex-poses patients who have undergone surgery for laryngeal sq-uamous cell carcinoma (SCC) to the risks of hypothyroidism and hypoparathyroidism 2 . Hypothyroidism related to sur-gery and radiotherapy for laryngeal SCC is widely acknowl-edged 3 4 . This incidence is reported to be between 65% and 95% 5-7 . Hypoparathyroidism can be found in 50%-73% of patients after having undergone total pharyngolaryngectomy 8 9 ; furthermore, it is related to surgery on the thyroid in 3%-32% of cases depending on the extent of the treatment 10 .With regard to laryngectomy combined with partial thy-roidectomy, hypoparathyroidism is estimated to occur in between 12% and 31% of cases 11 .Only one study linked the exposure to radiation to the onset of hyperparathyroidism 12 .Material and methodsA series of patients treated for laryngeal SCC, from June 2002 to June 2003, were included in this research. An Eth-ics Committee is not available in our institution, albeit valid consent was obtained from the patients with a personal permission document, in keeping with the mandate of the Declaration of Helsinki.Age, at the time of treatment, ranged from 58 to 78 years (mean 66.7). Selection criteria included: absence of thyroid ACTA OTORHinOLARYngOLOgiCA iTALiCA 2007;27:123-125Acta Otorhinolaryngol Ital 2007;27:123-125