Conti-Freitas Luiz Carlos, Foss-Freitas Maria Cristina, Lucca Leandro Junior, da Costa Jose Abrão Cardeal, Mamede Rui Celso Martins, Foss Milton Cesar
Department of Ophthalmology, Otolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School of São Paulo University-USP, Ribeirão Preto, Brazil.
World J Surg. 2009 Jul;33(7):1403-7. doi: 10.1007/s00268-009-0057-8.
Secondary hyperparathyroidism is a common complication in uremic patients. Total parathyroidectomy combined with partial autotransplantation into brachioradialis muscle has been the preference among the options for surgical treatment. This study was designed to evaluate the reserve and ability of suppression of autotransplanted parathyroid tissue using dynamics tests.
We studied, prospectively, 12 patients in recent (RP) and late (LP) postoperative of total parathyroidectomy with autotransplantation. For analysis of the secretory reserve capacity, we induced hypocalcemia by ethylenediaminetetraacetic acid (EDTA) infusion. Furthermore, for analysis of the ability for parathyroid hormone (PTH) suppression, the hypercalcemia test was used, by intravenous administration of calcium in LP.
In RP, there was a decrease in the average serum levels of PTH, phosphorus, and alkaline phosphatase, which ranged from 13 to 231 (87 +/- 65) pg/ml, 2.3 to 6.2 (3.3 +/- 1.1) mg/dl, and 77 to 504 (250 +/- 135) U/L, respectively, similar to that observed in LP. The analysis of the average curve of variations in PTH during testing of the stimulus with EDTA showed lack of secretion in RP and partial response in LP. Impaired suppression ability of the graft in LP was observed in the test with intravenous calcium.
Total parathyroidectomy followed by partial autotransplantation was effective in reducing PTH serum levels in patients with terminal kidney disease. The elevation of serum calcium during the suppression test was not able to inhibit the autograft gland secretion of PTH. The assessment of parathyroid graft function demonstrated an inability to respond to the stimulus of hypocalcemia induced by EDTA, although there was a partial recovery, in late postoperative period.
继发性甲状旁腺功能亢进是尿毒症患者常见的并发症。甲状旁腺全切除术联合部分甲状旁腺组织自体移植至肱桡肌一直是手术治疗方案中的首选。本研究旨在通过动态试验评估自体移植甲状旁腺组织的储备和抑制能力。
我们前瞻性地研究了12例甲状旁腺全切除并自体移植术后近期（RP）和远期（LP）的患者。为分析分泌储备能力，我们通过静脉输注乙二胺四乙酸（EDTA）诱导低钙血症。此外，为分析甲状旁腺激素（PTH）抑制能力，在远期患者中通过静脉注射钙剂进行高钙血症试验。
在近期，PTH、磷和碱性磷酸酶的平均血清水平均下降，分别从13至231（87±65）pg/ml、2.3至6.2（3.3±1.1）mg/dl和77至504（250±135）U/L降至与远期观察到的水平相似。在用EDTA刺激试验期间对PTH变化平均曲线的分析显示，近期患者无分泌，远期患者有部分反应。在静脉注射钙剂试验中观察到远期患者移植物的抑制能力受损。
甲状旁腺全切除术后行部分自体移植可有效降低终末期肾病患者的血清PTH水平。抑制试验期间血清钙升高未能抑制自体移植腺体分泌PTH。甲状旁腺移植物功能评估显示，尽管在术后晚期有部分恢复，但无法对EDTA诱导的低钙血症刺激作出反应。
