Tominaga Yoshihiro, Kakuta Takatoshi, Yasunaga Chikao, Nakamura Michio, Kadokura Yoshiyuki, Tahara Hideki
Department of Transplant and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, Nagoya, Japan.
Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Hachioji, Japan.
Ther Apher Dial. 2016 Feb;20(1):6-11. doi: 10.1111/1744-9987.12352.
Secondary hyperparathyroidism (SHPT) remains a serious complication in patients with chronic kidney disease, and some patients require parathyroidectomy. The Parathyroid Surgeons' Society of Japan (PSSJ) evaluated parathyroidectomy for SHPT and tertiary hyperparathyroidism (THPT) in Japan. The annual numbers of parathyroidectomies between 2004 and 2013 were evaluated using questionnaires. Since 2010, the PSSJ has registered the patients. In total, 826 patients from 42 institutions were registered. The annual number of parathyroidectomies for SHPT and THPT in Japan increased from 2004 to 2007 and then decreased markedly after 2007, with 296 operations performed in 2013. The number of women and men was almost equal (397/427). Median (interquartile range) age of these patients was 59.0 (24-87) years, the duration of hemodialysis before parathyroidectomy was 10.83 (0.0-38.7) years, and diabetic nephropathy was 87/826 (10.5%). Of these patients 59.6% were treated with cinacalcet at undergoing parathyroidectomy. In 75.3% of patients, a total parathyroidectomy with forearm autograft was performed. In 77.7% of patients, four or more parathyroid glands were removed during the initial operation. The incidences of husky voice and wound hemorrhage were 2.9% and 1.1%, respectively. The number of parathyroidectomies for SHPT in Japan decreased markedly after the introduction of cinacalcet. Based on the evaluation of registered patients, parathyroidectomies have been successfully performed at the institutions participating in the PSSJ.
继发性甲状旁腺功能亢进（SHPT）仍是慢性肾病患者的一种严重并发症，部分患者需要进行甲状旁腺切除术。日本甲状旁腺外科医师协会（PSSJ）对日本SHPT和三发性甲状旁腺功能亢进（THPT）的甲状旁腺切除术进行了评估。通过问卷调查评估了2004年至2013年间甲状旁腺切除术的年度数量。自2010年起，PSSJ开始对患者进行登记。共有来自42家机构的826例患者进行了登记。日本SHPT和THPT的甲状旁腺切除术年度数量在2004年至2007年增加，之后在2007年后显著下降，2013年进行了296例手术。女性和男性数量几乎相等（397/427）。这些患者的年龄中位数（四分位间距）为59.0（24 - 87）岁，甲状旁腺切除术前血液透析时间为10.83（0.0 - 38.7）年，糖尿病肾病患者为87/826（10.5%）。这些患者中59.6%在接受甲状旁腺切除术时接受了西那卡塞治疗。75.3%的患者进行了甲状旁腺全切术加前臂自体移植。77.7%的患者在初次手术时切除了四个或更多甲状旁腺。声音嘶哑和伤口出血的发生率分别为2.9%和1.1%。西那卡塞引入后，日本SHPT的甲状旁腺切除术数量显著下降。基于对登记患者的评估，参与PSSJ的机构已成功实施了甲状旁腺切除术。
