Background. In our country some aspects of thyroid and parathyroid surgery are still discussed. Aim. To present our experience in surgical treatment of benign diseases of the thyroid and parathyroid glands. Materials and methods. A retrospective analysis of the results of surgical treatment of 1511 patients with thyroid and parathyroid disease was performed. Results. Thyroidectomy was performed in 73.6 % of cases with thyroid diseases. The frequency of postoperative complications: laryngeal paresis -1.37 %, hypoparathyroidism -0.84 %, hemorrhagic complications -1.2 %. Selective parathyroidectomy was performed in 99 % of cases with primary hyperparathyroidism. Persistent hypoparathyroidism and laryngeal paresis have not been identified. Total parathyroidectomy with central neck dissection, upper mediastinum and upper horn of the thymus gland was performed in 66.3 % of cases with secondary hyperparathyroidism. Persistent laryngeal paresis was established in 3.3 % of cases, hemorrhagic complications -in 3.3 %. Conclusions. Constant analysis of our own results gives us reasons for our own attitude to the controversial issues of thyroid and parathyroid surgery. Presently, we prefer thyroidectomy in the treatment of diffuse toxic goiter and multinodular goiter, hemithyroidectomy -for the single-node goiter. In the surgical treatment of primary and uremic hyperparathyroidism, we consider mandatory the use of intraoperative monitoring of intact parathyroid hormone. When performing total parathyroidectomy, we perform the autotransplantation of the fragment of the parathyroid gland.

Иркутский научный центр хирургии и травматологии 1 , Иркутский государственный медицинский университет 2 , Иркутская областная клиническая больница 3 , г. Иркутск, Российская ФедерацияЦель. Исследовать уровень FGF23 до и после хирургического лечения вторичного гиперпаратиреоза и в группах сравнения у пациентов, получающих гемодиализ, разделенных по уровню паратиреоидного гормона, и у практически здоровых людей.Материал и методы. Исследован одномоментно уровень фактора роста фибробластов -23 (FGF23; пг/мл) в крови до и после хирургического лечения по поводу вторичного гиперпаратиреоза у пациентов, получающих заместительную почечную терапию гемодиализом. В группах сравнения исследован уровень FGF23 в крови у пациентов, получающих хронический гемодиализ. Группы разделены в зависимости от уровня интактного паратиреоидного гормона (ПТГ) в крови: с гипопаратиреозом (ПТГ меньше 130 пг/мл), с допустимым уровнем ПТГ (130-600 пг/мл) и гиперпаратиреозом (ПТГ больше 600 пг/мл). Также исследован уровень FGF23 у здоровых лиц. Всего исследовано 77 человек (33 женщины, 44 мужчины). Для оценки минерально-костных нарушений выполнено стандартное лабораторное обследование: биохимический анализ крови с электролитами (альбумин, общий кальций с коррекцией по альбумину, фосфор), ПТГ в крови.Результаты. Получены данные, что уровень FGF23 в группе здоровых людей статистически ниже, чем в остальных группах (pU=0,001). Между группами людей с терминальной стадией хронической болезни почек различие FGF23 статистически не достоверно (pU>0,05).Заключение. У всех пациентов, получающих диализ, независимо от выраженности вторичного гиперпаратиреоза до и после хирургического лечения, имеется повышенный уровень FGF23 в сравнении со здоровыми людьми. Статистически достоверных различий по уровню FGF23 в зависимости от наличия или отсутствия вторичного гиперпаратиреоза и результата хирургического лечения вторичного гиперпаратиреоза не выявлено. Согласно полученным данным, необходимо проведение дальнейших исследований, направленных на выявление роли FGF23 в патогенезе вторичного гиперпаратиреоза.Ключевые слова: вторичный гиперпаратиреоз, хроническая почечная болезнь, фосфатонин, фактор роста фибробластов -23, FGF23, минерально-костные нарушения Objective. To study the level of FGF23 before and after thesecondary hyperparathyroidism surgical treatment and in the comparison groups in patients receiving hemodialysis divided by the level of parathyroid hormone and in healthy people.Methods. The level of FGF23; pg/ml in the blood was simultaneouslystudied before and after surgical treatment for secondary hyperparathyroidism in patients undergoing renal replacement therapy. In the comparison groups, the level of FGF23 in the blood was studied in patients receiving dialysis for the terminal stage of chronic kidney disease (CKD). The groups were divided according to the level of intact parathyroid hormone (PTH) in the blood: with hypoparathyroidism (PTH less than 130 pg/ml), with an acceptable level of PTH (130-600 pg/ml), and hyperparathyroidism (PTH more than...

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p > 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence.

Parathyroidectomy is the leading treatment for drug-refractory secondary and tertiary hyperparathyroidism in patients with chronic kidney disease. Difficulties in performing this surgery are mainly associated with the anatomical features of the parathyroid glands, in particular with the variability of their number and topographic anatomy. Ectopic parathyroid glands are one of the most common causes of persistence or recurrence of secondary hyperparathyroidism after surgery. One of the common variants of ectopia is the localization of the parathyroid gland in the anterior-superior mediastinum. The article discusses the features of surgical treatment of secondary hyperparathyroidism in patients with end-stage chronic kidney disease with this ectopia. A new method of treating hyperparathyroidism in patients with an atypical location of the parathyroid gland in the anterior-superior mediastinum is presented. This method is characterized by low invasiveness of access, ease of implementation without using special equipment and instruments. The proposed method was used in the treatment of a patient with secondary hyperparathyroidism due to chronic renal failure as a result of chronic glomerulonephritis. The duration of hemodialysis at the time of the surgery was more than 17 years. In the presented clinical case, ectopia of one of the pathologically altered parathyroid glands in the anterior-superior mediastinum was found at the preoperative stage. As a method of surgical treatment, we carried out total parathyroidectomy with autotransplantation of a fragment of parathyroid tissue into the brachioradialis muscle. Thanks to this method, it was possible to remove the atypically located parathyroid gland from the cervicotomy access and to discharge the patient within the standard terms for a given volume of surgery.

The paper discusses the significance of animal experiments and modeling of pathological processes for pre-clinical drug trials, methods of diagnostics and treatment, which correspond to the concept of the first phase of the study in translational medicine. The article provides information on the methodology, legal framework and applications of experimental surgery. The simulation results of dyslipidemia and hypoparathyroidism are given. Simulation of pathology in small laboratory animals is regarded as an integral component of basic and applied biomedical research.