Gourgiotis Stavros, Moustafellos Panagiotis, Stratopoulos Charalabos, Vougas Vasilis, Drakopoulos Spiros, Hadjiyannakis Evangelos
First Surgical Department Organ Transplant Unit, Evangelismos General Hospital, Athens, Greece.
Hormones (Athens). 2006 Oct-Dec;5(4):270-5. doi: 10.14310/horm.2002.11192.
renal hyperparathyroidism (rH) is one of the most serious complications in long-term hemodialysis patients. the purpose of this retrospective study was the evaluation of the surgical indications, parathyroid histology, and the results of total parathyroidectomy with autotransplantation (Ptx+At) in patients with rH.
the study included 36 patients with rH in whom Ptx+At was carried out at the First surgical Department of the Evangelismos Hospital over a 5-year period. Indications for Ptx+At were high levels of parathyroid hormone (PtH >800 ng/L) associated with hypercalcemia and/or hyperphosphatemia, that were refractory to medical treatment, as well as clinical effects of rH, including pruritus, bone and joints pain, muscle weakness, progression of soft tissue calcification, and spontaneous fractures. Ultrasonography, (99m)Tc sestamibi scan and computed tomography were used to evaluate the thyroid and parathyroids.
there was no mortality related to surgery. Preoperative symptoms, serum PtH, serum alkaline phosphatace, hyperphosphatemia, and hypercalcemia were improved or normalised in most patients. recurrence was observed in one case; this autotransplanted patient required resection of transplanted tissue from his forearm. Hypoparathyroidism was not recorded.
Ptx+At is a safe option for the treatment of rH that is accompanied by low morbidity, mortality, and recurrence rate. It is important to identify all parathyroid glands at surgery and to choose adequate parathyroid tissue for autograft.
肾性甲状旁腺功能亢进（rH）是长期血液透析患者最严重的并发症之一。本回顾性研究的目的是评估rH患者的手术指征、甲状旁腺组织学以及甲状旁腺全切加自体移植（Ptx+At）的结果。
本研究纳入了36例rH患者，他们在5年期间于 Evangelismos 医院第一外科接受了 Ptx+At 手术。Ptx+At 的指征是甲状旁腺激素水平高（PtH>800 ng/L）并伴有高钙血症和/或高磷血症，且对药物治疗无效，以及rH的临床症状，包括瘙痒、骨和关节疼痛、肌肉无力、软组织钙化进展和自发性骨折。使用超声、（99m）Tc 甲氧基异丁基异腈扫描和计算机断层扫描来评估甲状腺和甲状旁腺。
无手术相关死亡。大多数患者的术前症状、血清PtH、血清碱性磷酸酶、高磷血症和高钙血症均得到改善或恢复正常。1例出现复发；该自体移植患者需要切除其前臂的移植组织。未记录到甲状旁腺功能减退。
Ptx+At 是治疗 rH 的一种安全选择，其发病率、死亡率和复发率较低。手术中识别所有甲状旁腺并选择合适的甲状旁腺组织进行自体移植很重要。
