Chow Tam-Lin, Chan Tony Tung-Fei, Ho Yiu-Wing, Lam Siu-Ho
Division of Head and Neck, Reconstructive and Breast Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
Arch Surg. 2007 Jul;142(7):644-8. doi: 10.1001/archsurg.142.7.644.
Most patients undergoing long-term dialysis are anemic because of underproduction of erythropoietin and its inhibition by high parathyroid hormone levels due to secondary hyperparathyroidism. Renal anemia can be improved by parathyroidectomy.
Retrospective cohort study.
Regional hospital.
Twenty-three Chinese patients without a previous functioning renal transplant underwent parathyroidectomy for severe secondary hyperparathyroidism in a 3-year period.
Total parathyroidectomy with or without parathyroid autograft at the forearm.
The preoperative and 6-month postoperative hematological and biochemical variables were compared for any differences by means of a paired t test.
The mean +/- SD follow-up duration was 17.7 +/- 8.1 (range, 6-34) months. Three patients (13%) developed persistent or recurrent hyperparathyroidism and 2 patients (9%) were biochemically hypoparathyroid. The other 18 patients (78%) were euparathyroid. Surgical morbidity was minimal; only 1 patient had complications, consisting of a postoperative fever of unknown origin that resolved with conservative treatment. The mean +/- SD hemoglobin level (8.6 +/- 2.1 vs 9.4 +/- 2.1 g/dL) but not the mean platelet level was significantly (P = .04) increased 6 months postoperatively. Likewise, the following other mean +/- SD biochemical values improved after surgery: parathyroid hormone (2235 +/- 500 vs 151 +/- 312 pg/mL; P<.001), alkaline phosphatase (645 +/- 349 vs 123 +/- 82 U/L; P<.001), calcium (10.8 +/- 4.0 vs 9.3 +/- 1.0 mg/dL; P<.001), phosphate (1.93 +/- 0.73 vs 1.50 +/- 0.51 mmol/L; P = .02), and albumin (3.5 +/- 0.5 vs 3.8 +/- 0.6 g/dL; P = .006).
Parathyroidectomy is highly effective to control secondary hyperparathyroidism with an exceedingly low complication rate. The hemoglobin level was significantly elevated 6 months postoperatively. The long-term effect warrants future trials.
大多数接受长期透析的患者贫血是由于促红细胞生成素生成不足以及继发甲状旁腺功能亢进导致的高甲状旁腺激素水平对其产生抑制作用。甲状旁腺切除术可改善肾性贫血。
回顾性队列研究。
地区医院。
23例未曾接受过功能性肾移植的中国患者在3年期间因严重继发性甲状旁腺功能亢进接受了甲状旁腺切除术。
行甲状旁腺全切术，可选择在前臂进行甲状旁腺自体移植。
通过配对t检验比较术前和术后6个月的血液学和生化指标有无差异。
平均随访时间为17.7±8.1（范围6 - 34）个月。3例患者（13%）出现持续性或复发性甲状旁腺功能亢进，2例患者（9%）出现生化性甲状旁腺功能减退。其他18例患者（78%）甲状旁腺功能正常。手术并发症极少；仅1例患者出现并发症，表现为不明原因的术后发热，经保守治疗后缓解。术后6个月，平均血红蛋白水平显著升高（8.6±2.1 vs 9.4±2.1 g/dL，P = 0.04），但平均血小板水平无显著变化。同样，术后其他平均生化指标也有所改善：甲状旁腺激素（2235±500 vs 151±312 pg/mL；P<0.001）、碱性磷酸酶（645±349 vs 123±82 U/L；P<0.001）、钙（10.8±4.0 vs 9.3±1.0 mg/dL；P<0.001）、磷（1.93±0.73 vs 1.50±0.51 mmol/L；P = 0.02）和白蛋白（3.5±0.5 vs 3.8±0.6 g/dL；P = 0.006）。
甲状旁腺切除术能有效控制继发性甲状旁腺功能亢进，并发症发生率极低。术后6个月血红蛋白水平显著升高。其长期效果有待进一步试验验证。
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