Olson John A, Leight George S
Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC 27710, USA
Adv Ren Replace Ther. 2002 Jul;9(3):209-18. doi: 10.1053/jarr.2002.34840.
Most patients with renal failure maintained on chronic dialysis have elevated parathyroid hormone (PTH) levels and PTH-mediated bone disease (secondary hyperparathyroidism [sHPT]). Elevated PTH production in this setting represents a progressive, exaggerated physiologic response to hypocalcemia by the parathyroid glands, and generalized growth of the parathyroids is an adaptive response to chronic stimulation. Effective medical strategies to reduce PTH secretion and PTH-mediated bone turnover in sHPT (eg, controlling hyperphosphatemia, normalizing serum calcium, and administering vitamin D analogs) has decreased the need for parathyroidectomy in recent years. However, failure of medical therapy because of inadequate treatment, persistent hyperphosphatemia, or acquired parathyroid neoplasia still leads to recommendations for parathyroidectomy in select patients. Furthermore, increased awareness of potential long-term, irreversible cardiovascular effects of uncorrected hyperparathyroidism has led some to advocate parathyroidectomy earlier in the course of this disease. This monograph will review parathyroidectomy for secondary and tertiary hyperparathyroidism.
大多数接受长期透析治疗的肾衰竭患者甲状旁腺激素（PTH）水平升高，存在PTH介导的骨病（继发性甲状旁腺功能亢进症[sHPT]）。在这种情况下，PTH分泌增加代表甲状旁腺对低钙血症的一种渐进性、过度的生理反应，甲状旁腺的普遍增生是对慢性刺激的一种适应性反应。近年来，在sHPT中降低PTH分泌和PTH介导的骨转换的有效医学策略（如控制高磷血症、使血清钙正常化以及给予维生素D类似物）减少了甲状旁腺切除术的需求。然而，由于治疗不足、持续性高磷血症或获得性甲状旁腺肿瘤导致的药物治疗失败，仍然使得部分患者需要接受甲状旁腺切除术。此外，对未纠正的甲状旁腺功能亢进潜在的长期、不可逆心血管影响的认识增加，促使一些人主张在该病病程早期进行甲状旁腺切除术。本专著将综述继发性和三发性甲状旁腺功能亢进症的甲状旁腺切除术。
