Dotzenrath C
Helios Klinikum Wuppertal, Klinik für Endokrine Chirurgie, Heusnerstraße 40, 42283, Wuppertal, Deutschland.
Chirurg. 2010 Oct;81(10):902-8. doi: 10.1007/s00104-010-1968-5.
New therapeutics for the treatment of chronic kidney disease and secondary hyperparathyroidism, such as calcium and aluminium-free phosphate binders, calcimimetic agents and active vitamin D metabolites may decrease the need for parathyroidectomy. The calcimimetic cinacalcet does not induce a longer lasting regression of renal hyperparathyroidism and autonomous growing of parathyroids and the therapeutic effect is limited to the period of treatment. The classical indications for surgery, hypercalcemia, vascular calcification, severe osteopathy, drug-resistant hyperphosphatemia and calciphylaxis are still valid if patients do not respond to medical therapy under the condition that adynamic bone disease is excluded. Individual operative risk factors and improvement of quality of life are important supplementary factors for the indication for parathyroidectomy.
用于治疗慢性肾脏病和继发性甲状旁腺功能亢进的新型疗法，如无钙和无铝的磷结合剂、拟钙剂和活性维生素D代谢物，可能会减少甲状旁腺切除术的需求。拟钙剂西那卡塞不会诱导肾性甲状旁腺功能亢进的持久消退和甲状旁腺的自主性生长，且治疗效果仅限于治疗期间。如果患者在排除动力缺失性骨病的情况下对药物治疗无反应，那么手术的经典指征，如高钙血症、血管钙化、严重骨病、耐药性高磷血症和钙化防御，仍然有效。个体手术风险因素和生活质量的改善是甲状旁腺切除术指征的重要补充因素。
