Basile C, Buisson C, Scatizzi A, Drüeke T, Dubost C
Divisione di Nefrologia, Ospedale SS. Annunziata, Taranto.
Minerva Med. 1989 Mar;80(3):289-93.
We report here the unusually difficult cases of two patients with end-stage renal failure who suffered from severe hyperparathyroidism requiring surgical correction. The first patient had previously undiagnosed primary hyperparathyroidism. A first surgical neck exploration led to the discovery of four glands, paradoxically normal in size and aspect, which were removed. Subsequently, a supernumerary gland was localized in the mediastinum by computerized tomography and removed via sternotomy. After confirming the hypoparathyroid state, parathyroid autotransplantation was performed using cryopreserved tissue. The second patient had five hyperplastic parathyroid glands removed during the first neck exploration, followed by immediate parathyroid autografting. Because of the persistence of severe hyperparathyroidism, forearm autografts were subsequently removed and a sternotomy performed. Both failed to improve parathyroid hyperfunction. Numerous localization procedures remained negative. A repeat surgical neck exploration was performed because of positive double isotope scanning but was of no success in preventing fatal outcome, as were all medical treatments. These observations of two patients illustrate the difficulties in localizing and removing ectopic parathyroid lesions. Even when relying on the presently available powerful diagnostic means, correction of severe hyperparathyroidism may be extremely difficult.
我们在此报告两例终末期肾衰竭患者的异常困难病例，这两名患者患有严重甲状旁腺功能亢进症，需要进行手术矫正。首例患者先前未被诊断出原发性甲状旁腺功能亢进症。首次颈部手术探查发现了四个甲状旁腺，其大小和外观出人意料地正常，遂将其切除。随后，通过计算机断层扫描在纵隔中定位到一个额外的甲状旁腺，并通过胸骨切开术将其切除。在确认甲状旁腺功能减退状态后，使用冷冻保存的组织进行了甲状旁腺自体移植。第二例患者在首次颈部探查时切除了五个增生的甲状旁腺，随后立即进行了甲状旁腺自体移植。由于严重甲状旁腺功能亢进症持续存在，随后切除了前臂自体移植组织并进行了胸骨切开术。两者均未能改善甲状旁腺功能亢进。多次定位检查结果均为阴性。由于双同位素扫描呈阳性，进行了再次颈部手术探查，但未能成功预防致命结局，所有药物治疗也同样无效。这两名患者的观察结果说明了定位和切除异位甲状旁腺病变的困难。即使依靠目前可用的强大诊断手段，矫正严重甲状旁腺功能亢进症也可能极其困难。
