Schneider Ralph, Karakas Elias, Bartsch Detlef K, Schlosser Katja
World J Surg. 2013 Dec;37(12):2866-71. doi: 10.1007/s00268-013-2185-4.
Restless legs syndrome (RLS) is a common and poorly understood movement disorder that leads to unpleasant leg sensations. Although RLS can be idiopathic, secondary etiologies such as iron deficiency and renal failure are common. The aim of this prospective cohort study was to evaluate whether RLS is a common feature in patients undergoing parathyroidectomy for renal hyperparathyroidism (rHPT) and if RLS-related symptoms can be influenced by surgery.
After providing written consent, patients who underwent a parathyroidectomy for rHPT between January and November 2011 answered a validated RLS-screening-questionnaire (RLSSQ). If this was suggestive for RLS a confirming questionnaire (IRLS) was also completed on the day before surgery, on the fifth postoperative day, and again during follow-up (minimum 12 months). Perioperative parathyroid hormone and calcium levels, as well as the scores of the questionnaires were analyzed.
Twenty-one patients (14 men, 7 women) with a mean age of 47.8 ± 3.2 years underwent total parathyroidectomy with bilateral cervical thymectomy and parathyroid autotransplantation for rHPT. The mean score of the RLSSQ of all 21 patients prior to operation was 6.1 ± 0.5. In 10 of 21 patients (47.6 %) the results of the RLSSQ were suggestive for RLS with a mean score of 8.0 ± 0.3. The consecutive scores of the IRLS in these latter patients significantly dropped from 26.6 ± 1.4 to 19.0 ± 2.2 between the preoperative and postoperative settings (p < 0.05). After a mean follow-up of 17.3 ± 3.7 months the mean scores of the RLSSQ and the IRLS were 6.1 ± 0.6 and 16.3 ± 1.8.
rHPT may play a major role in the severity of RLS-associated symptoms in patients with renal failure. Consequently, parathyroidectomy may prove to be a valuable tool to reduce RLS-associated morbidity in affected patients. However, larger prospective trials are required to confirm the possible relation between RLS and rHPT seen in the present study
不宁腿综合征（RLS）是一种常见但了解甚少的运动障碍，会导致腿部产生不适感。尽管RLS可能是特发性的，但诸如缺铁和肾衰竭等继发性病因也很常见。这项前瞻性队列研究的目的是评估RLS在因肾性甲状旁腺功能亢进症（rHPT）接受甲状旁腺切除术的患者中是否为常见特征，以及与RLS相关的症状是否会受到手术影响。
在获得书面同意后，于2011年1月至11月间因rHPT接受甲状旁腺切除术的患者回答了一份经过验证的RLS筛查问卷（RLSSQ）。如果该问卷提示可能患有RLS，则还需在手术前一天、术后第五天以及随访期间（至少12个月）完成一份确认问卷（IRLS）。分析围手术期甲状旁腺激素和钙水平以及问卷得分。
21例患者（14例男性，7例女性），平均年龄47.8±3.2岁，因rHPT接受了全甲状旁腺切除术并双侧颈胸腺切除术及甲状旁腺自体移植。所有21例患者术前RLSSQ的平均得分为6.1±0.5。21例患者中有10例（47.6%）的RLSSQ结果提示患有RLS，平均得分为8.0±0.3。在这些患者中，术前至术后IRLS的连续得分从26.6±1.4显著降至19.0±2.2（p<0.05）。平均随访17.3±3.7个月后，RLSSQ和IRLS的平均得分分别为6.1±0.6和16.3±1.8。
rHPT可能在肾衰竭患者中RLS相关症状的严重程度方面起主要作用。因此，甲状旁腺切除术可能被证明是减轻受影响患者中RLS相关发病率的一种有价值的手段。然而，需要更大规模的前瞻性试验来证实本研究中所见的RLS与rHPT之间的可能关系。
