肾透析患者肌内及皮下前臂甲状旁腺自体移植增生：一项回顾性队列研究。

Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: A retrospective cohort study.

作者信息

Hsu Yu-Chen, Hung Chung-Jye

机构信息

Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, Sin-Hua Branch, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.

Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

出版信息

Surgery. 2015 Nov;158(5):1331-8. doi: 10.1016/j.surg.2015.04.027. Epub 2015 Jun 6.

DOI:10.1016/j.surg.2015.04.027

PMID:26054321

Abstract

BACKGROUND

Intramuscular and subcutaneous forearm parathyroid autograft are proved to have compatible short-term outcome. However, long-term clinical courses have not been studied.

METHODS

A single-surgeon retrospective cohort study of parathyroid autograft hyperplasia from August 1998 to January 2013 was performed. According to the location of their parathyroid autograft, patients were divided into an Intramuscular group and a Subcutaneous group. Clinical parameters were analyzed to assess the risk factors and clinical course of autograft hyperplasia.

RESULTS

There were 888 consecutive patients who underwent total parathyroidectomy with forearm autotransplantation for renal hyperparathyroidism during the period. The median age at the time of total parathyroidectomy with forearm autotransplantation was 54.2 years (range, 12-86) and the median follow-up time was 4.0 years (range 0.1-16). Autograftectomy was performed on 29 of 888 patients. The incidence of autograftectomy was 15 of 65 in the Intramuscular group and 14 of 823 in the Subcutaneous group; the incidence of repeated autograftectomy was 4 of 65 in the Intramuscular group and 1 of 823 in the Subcutaneous group. The cumulative frequency of autograftectomy was greater in the Intramuscular group than that in the Subcutaneous group (11.6 vs 3.1% at 6 years, P < .001). The location of the autograft was the only significant factor affecting the autograftectomy frequency (P = .002). The Intramuscular group reoperation patients experienced a longer period between their first operation and the autograftectomy (6.6 vs 3.3 years, P = .003), longer operating times (79 vs 37 minutes, P = .002), and a greater level of pre-autograftectomy systemic intact parathyroid hormone (1,044 vs 559 ng/L, P = .014) than the Subcutaneous group.

CONCLUSION

Intramuscular parathyroid autotransplantation results in a high incidence of autograftectomy, repeated autograftectomy, and a high cumulative frequency of autograftectomy.

摘要

背景

肌内和皮下前臂甲状旁腺自体移植已被证明具有良好的短期效果。然而，尚未对其长期临床病程进行研究。

方法

对1998年8月至2013年1月期间因甲状旁腺自体移植增生而进行的单术者回顾性队列研究。根据甲状旁腺自体移植的位置，将患者分为肌内组和皮下组。分析临床参数以评估自体移植增生的危险因素和临床病程。

结果

在此期间，共有888例患者因肾性甲状旁腺功能亢进接受了全甲状旁腺切除术并进行了前臂自体移植。全甲状旁腺切除术并前臂自体移植时的中位年龄为54.2岁（范围12 - 86岁），中位随访时间为4.0年（范围0.1 - 16年）。888例患者中有29例进行了自体移植切除。肌内组65例中有15例进行了自体移植切除，皮下组823例中有14例进行了自体移植切除；肌内组65例中有4例进行了重复自体移植切除，皮下组823例中有1例进行了重复自体移植切除。肌内组自体移植切除的累积频率高于皮下组（6年时分别为11.6%和3.1%，P <.001）。自体移植的位置是影响自体移植切除频率的唯一显著因素（P =.002）。与皮下组相比，肌内组再次手术患者首次手术至自体移植切除的间隔时间更长（6.6年对3.3年，P =.003），手术时间更长（79分钟对37分钟，P =.002），自体移植切除术前全身完整甲状旁腺激素水平更高（1,044 ng/L对559 ng/L，P =.014）。