Conzo G, Stanzione F, Palazzo A, Della Pietra C, Candilio G, Celsi S, Livrea A
Departmento di Internistica Clinica e Sperimentale, Magrassi-Lanzara, Seconda Universitá degli Studi di Napoli, Italy.
G Chir. 2010 Jun-Jul;31(6-7):316-8.
To date surgical treatment of secondary hyperparathyroidism (HPTs) is still controversial. Subtotal parathyroidectomy with sparing of a part of not-nodular gland and total parathyroidectomy with autotransplantation (subcutaneous or muscular) represent the most common procedures with the aim to warrant a condition of euparathyroidism. Total parathyroidectomy (or so presumed) represent an unusual therapeutic option as the risks arising from aparathyroidism and from the need of a substitutive therapy are largely known. The authors evaluate the surgical results collected from 47 consecutive patients affected by HPTs and Chronic Renal Failure (CRF) and operated on between January 1999 and January 2006. Probably, a proper indication to the type of surgical procedure could be based on the severity of the disease, on the age of the patient and on the expectation of transplant. The significant incidence of recurrence and persistent disease is due to autoimplantation or residual gland hypertrophy after subtotal parathyroidectomy, to the presence of supernumerary or ectopic glands, to cervico-mediastinic hypertrophy of cellular foci. The identification and removal of supernumerary glands, which may cause persisting hyperparathyroidism, is mandatory.
迄今为止，继发性甲状旁腺功能亢进（HPTs）的外科治疗仍存在争议。保留部分非结节性腺体的甲状旁腺次全切除术以及甲状旁腺全切除术加自体移植（皮下或肌肉内）是最常见的手术方式，目的是确保甲状旁腺功能正常。甲状旁腺全切除术（或被认为如此）是一种不常见的治疗选择，因为甲状旁腺功能减退症以及替代治疗需求所带来的风险广为人知。作者评估了1999年1月至2006年1月期间连续47例患有HPTs和慢性肾衰竭（CRF）并接受手术治疗的患者的手术结果。或许，手术方式的恰当选择可以基于疾病的严重程度、患者年龄以及移植预期。复发和持续性疾病的显著发生率是由于甲状旁腺次全切除术后自体移植或残留腺体肥大、存在多余或异位腺体、颈部-纵隔细胞灶肥大。识别并切除可能导致持续性甲状旁腺功能亢进的多余腺体是必不可少的。
