Stracke S, Jehle P M, Sturm D, Schoenberg M H, Widmaier U, Beger H G, Keller F
University of Ulm, Department of Surgery, Germany.
Am J Kidney Dis. 1999 Feb;33(2):304-11. doi: 10.1016/s0272-6386(99)70305-7.
In patients with chronic renal failure, hyperparathyroidism is a common problem and surgical parathyroidectomy (PTX) is frequently required. The three different surgical approaches are subtotal PTX, total PTX with autotransplantation, and total PTX without autotransplantation. Recurrence of hyperparathyroidism varies from 5% to 80% in different studies for the first two surgical approaches. To minimize the risk for recurrence, and because we fear severe relapses with calciphylaxia, we perform total PTX without autotransplantation. From October 1993 to October 1997, 20 patients (9 men and 11 women) underwent total PTX without autotransplantation (median age, 52 years; range, 23 to 74 years; median dialysis time before PTX, 6.5 years; range, 1 to 22 years). All patients were supplemented with vitamin D analogues postoperatively. Patients were followed up for 1 to 48 months (median, 20 months). Bone pain, when present, disappeared within the first week after total PTX. Postoperatively, most patients had temporary hypocalcemia. In the long term, five patients had asymptomatic hypocalcemia. One patient, however, repeatedly had hypocalcemic seizures. Five patients developed asymptomatic hypercalcemia when supplemented with calcitriol. At the end of the individual's observation time, parathyroid hormone (PTH) levels were less than normal in six patients, normal in seven patients, and increased in seven patients despite total PTX. We conclude that total PTX should be reconsidered an option for the treatment of hyperparathyroidism secondary to renal failure. There was no evidence of clinical bone disease after total PTX. Apparently, remaining ectopic parathyroid tissue accounts for PTH levels after total PTX.
在慢性肾衰竭患者中，甲状旁腺功能亢进是一个常见问题，通常需要进行甲状旁腺手术切除（PTX）。三种不同的手术方法是次全PTX、带自体移植的全PTX和不带自体移植的全PTX。在前两种手术方法的不同研究中，甲状旁腺功能亢进的复发率在5%至80%之间。为了将复发风险降至最低，并且因为我们担心钙化防御导致的严重复发，我们进行不带自体移植的全PTX。从1993年10月至1997年10月，20例患者（9例男性和11例女性）接受了不带自体移植的全PTX（中位年龄52岁；范围23至74岁；PTX前中位透析时间6.5年；范围1至22年）。所有患者术后均补充维生素D类似物。对患者进行了1至48个月的随访（中位时间20个月）。存在的骨痛在全PTX后的第一周内消失。术后，大多数患者出现暂时性低钙血症。从长期来看，5例患者有无症状性低钙血症。然而，1例患者反复出现低钙性惊厥。5例患者在补充骨化三醇时出现无症状性高钙血症。在个体观察期结束时，6例患者的甲状旁腺激素（PTH）水平低于正常，7例患者正常，7例患者尽管进行了全PTX但PTH水平仍升高。我们得出结论，全PTX应重新被视为治疗肾衰竭继发性甲状旁腺功能亢进的一种选择。全PTX后没有临床骨病的证据。显然，残留的异位甲状旁腺组织是全PTX后PTH水平升高的原因。
