Baker L R, Otieno L S, Brown A L, Carroll M J, Cattell W R, Farrington K
Renal Unit, St. Bartholomew's Hospital, London, UK.
Am J Nephrol. 1991;11(3):186-91. doi: 10.1159/000168301.
We have described 4 patients with chronic renal failure receiving regular haemodialysis treatment who underwent total parathyroidectomy with autotransplantation of parathyroid fragments into the forearm musculature for hypercalcaemic hyperparathyroidism. In all, there was an immediate and profound fall in plasma calcium levels. Hypercalcaemia recurred 1-5 years post-operatively and was resistant to resection of the autograft. In 3 cases, thallium-technetium subtraction scanning and multiple venous sampling for estimation of parathyroid hormone levels suggested multiple sites of hypersecretion of parathyroid hormone in the neck. In 1 case, these investigations revealed a mediastinal adenoma which was successfully removed. These cases reinforce previous suggestions that total parathyroidectomy is frequently incomplete and undermine the procedure of total parathyroidectomy with autotransplantation in patients with persisting uraemia.
我们描述了4例接受定期血液透析治疗的慢性肾衰竭患者，他们因高钙血症性甲状旁腺功能亢进接受了甲状旁腺全切术，并将甲状旁腺碎片自体移植到前臂肌肉组织中。总体而言，血浆钙水平立即出现显著下降。高钙血症在术后1至5年复发，且对自体移植组织的切除具有抗性。在3例病例中，铊-锝减影扫描和多次静脉采血以评估甲状旁腺激素水平提示颈部存在多个甲状旁腺激素分泌过多的部位。在1例病例中，这些检查发现了一个纵隔腺瘤，并成功将其切除。这些病例强化了之前的观点，即甲状旁腺全切术常常不彻底，并且削弱了在持续性尿毒症患者中进行甲状旁腺全切术并自体移植的手术效果。
