Drakopoulos Spiros, Koukoulaki Maria, Apostolou Theofanis, Pistolas Dimitrios, Balaska Katerina, Gavriil Stylianos, Hadjiconstantinou Valsamakis
Transplant Unit, Evangelismos General Hospital of Athens, 45-47 Ipsilantou Street, Athens 10676, Greece.
Am J Surg. 2009 Aug;198(2):178-83. doi: 10.1016/j.amjsurg.2008.08.017. Epub 2009 Feb 13.
Persistent secondary hyperparathyroidism not responding to medication is treated successfully with surgical excision of parathyroid glands (total parathyroidectomy [PTX]). PTX without autotransplantation of parathyroid glands excludes the risk for recurrence of hyperparathyroidism.
During the years 2002 to 2005, 36 total parathyroidectomies were performed in 33 patients: 21 dialysis patients because of end-stage renal disease and 12 renal transplant recipients.
PTX without autotransplantation was performed successfully in 33 patients, whereas 3 patients were reoperated for remaining parathyroid glands. Immediate improvement of clinical symptoms and a decrease of serum calcium and parathormone levels were observed after surgical procedures. Oral replacement treatment with vitamin D (1a-calcidiol) and calcium was commenced and long-term follow-up evaluation (23.5 +/- 7.6 mo) showed that calcium homeostasis was controlled adequately.
PTX without autotransplantation is a safe and effective surgical procedure for the treatment of resistant secondary hyperparathyroidism with immediate response of clinical symptoms. Replacement treatment with vitamin D and calcium provides satisfactory coverage of individual needs.
药物治疗无效的持续性继发性甲状旁腺功能亢进通过甲状旁腺手术切除（甲状旁腺全切术[PTX]）可成功治疗。不进行甲状旁腺自体移植的PTX可排除甲状旁腺功能亢进复发的风险。
2002年至2005年期间，对33例患者实施了36次甲状旁腺全切术：21例因终末期肾病的透析患者和12例肾移植受者。
33例患者成功实施了不进行自体移植的PTX，3例患者因残留甲状旁腺而再次手术。手术后观察到临床症状立即改善，血清钙和甲状旁腺激素水平下降。开始口服维生素D（1α-骨化二醇）和钙进行替代治疗，长期随访评估（23.5±7.6个月）显示钙稳态得到充分控制。
不进行自体移植的PTX是治疗难治性继发性甲状旁腺功能亢进的一种安全有效的手术方法，临床症状可立即得到缓解。维生素D和钙的替代治疗能满足个体的需求。
