The indications for surgical treatment of renal HPT in patients with chronic endstage renal failure are symptomatic disease or failed medical management. The indications for patients who have had a kidney transplant are symptomatic disease and persistent hypercalcemia. It should be noted, however, that the current approach favored in the literature in asymptomatic, mild post-transplant hyperparathyroidism is conservative. Total parathyroidectomy with autotransplantation is the most popular surgical method reported. I have done subtotal parathyroidectomy and reserved total parathyroidectomy for selected patients. My recurrence rate is comparable to that reported. The actual survival rate in our two groups of patients was 58 percent for the dialysis patients and 79 percent for the transplant patients. The actuarial survival rates at 1, 5, and 10 years in the two groups were 95 and 92 percent; 59 and 67 percent; and 32 and 67 percent. The use of diphosphonates and medical rather than surgical control needs further study, as do the long-term effects of conservative treatment of asymptomatic post-transplant hyperparathyroidism.
对于慢性终末期肾衰竭患者，肾性甲状旁腺功能亢进症的手术治疗指征为出现症状性疾病或药物治疗失败。对于接受肾移植的患者，手术治疗指征为出现症状性疾病和持续性高钙血症。然而，应当注意的是，目前文献中对于无症状、轻度移植后甲状旁腺功能亢进症所倾向的方法是保守治疗。甲状旁腺全切加自体移植是报道中最常用的手术方法。我做过甲状旁腺次全切除术，并为特定患者保留了甲状旁腺全切术。我的复发率与报道的复发率相当。我们两组患者的实际生存率，透析患者为58%，移植患者为79%。两组患者1年、5年和10年的精算生存率分别为95%和92%；59%和67%；32%和67%。双膦酸盐的使用以及采用药物而非手术控制，与无症状移植后甲状旁腺功能亢进症保守治疗的长期效果一样，都需要进一步研究。
