慢性肾衰竭复发性高钙血症甲状旁腺自体移植后的系列外植术
Serial explantation after parathyroid autotransplant for recurrent hypercalcemia in chronic renal failure.
作者信息
Foley William Robert, Lundon Dara, O'Meara Yvonnne, Gorey Tom
机构信息
School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland ; Department of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland.
出版信息
Int J Endocrinol Metab. 2014 Apr 1;12(2):e14102. doi: 10.5812/ijem.14102. eCollection 2014 Apr.
INTRODUCTION
Development of autonomous parathyroid gland function can occur in cases of long standing renal disease, leading to hyperparathyroidism and hypercalcemia. Debate exists over the optimum surgical treatment strategy and the choice lies with the individual surgeon. We illustrated the method of total parathyroidectomy and autotransplantation to the forearm and proposed it to be superior to both total and subtotal parathyroidectomy.
CASE PRESENTATION
This case illustrated the development of secondary and subsequently tertiary hyperparathyroidism in a 66-year-old man with a history of chronic renal failure. The patient was managed surgically by parathyroid autotransplantation and serial explantation.
DISCUSSION
Refractory hypercalcemia due to autonomous parathyroid tissue following parathyroidectomy can be managed with greater ease and efficacy by serial explantation of autotransplanted tissue versus a more difficult re-exploration of the neck.
引言
长期肾病患者可能会出现甲状旁腺自主功能，导致甲状旁腺功能亢进和高钙血症。关于最佳手术治疗策略存在争议，具体选择取决于外科医生个人。我们阐述了甲状旁腺全切除术及自体移植至前臂的方法，并认为该方法优于甲状旁腺全切除术和次全切除术。
病例介绍
该病例展示了一名66岁有慢性肾衰竭病史男性患者继发性及随后的三发性甲状旁腺功能亢进的发展过程。该患者通过甲状旁腺自体移植和连续取出术进行手术治疗。
讨论
甲状旁腺切除术后由于甲状旁腺自主组织导致的难治性高钙血症，通过连续取出自体移植组织比再次进行难度更大的颈部探查更容易且更有效地进行处理。
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