Konturek Aleksander, Barczyński Marcin, Stopa Małgorzata, Nowak Wojciech
Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Prądnicka Street, 31-202, Krakow, Poland.
Langenbecks Arch Surg. 2016 Nov;401(7):965-974. doi: 10.1007/s00423-016-1447-7. Epub 2016 May 27.
The aim of this study was to evaluate the outcomes of surgery for patients with secondary renal hyperparathyroidism (rHPT).
This is a retrospective cohort study. Our institutional database was searched for eligible patients treated in 1995-2014. The inclusion criterion was initial parathyroidectomy for rHPT. Clinical and follow-up data were analyzed to estimate the cure rate (primary outcome), and morbidity (secondary outcome).
The study group comprised 297 patients (154 females, age 44.5 ± 13.7 years, follow-up 24.6 ± 10.5 months), including 268 (90.2 %) patients who had underwent subtotal parathyroidectomy, and 29 (9.8 %) who had had incomplete parathyroidectomy. Intraoperative iPTH assay was utilized in 207 (69.7 %) explorations. Persistent rHPT occurred in 12/268 (4.5 %) patients after subtotal parathyroidectomy and 5/29 (17.2 %) subjects after incomplete parathyroidectomy (p = 0.005). The patients operated on with intraoperative iPTH assay had a higher cure rate than non-monitored individuals, 201/207 (97.1 %) vs. 79/90 (87.8 %), respectively (p = 0.001). In-hospital mortality occurred in 1/297 (0.3 %) patient. The hungry bone syndrome occurred in 84/268 (31.3 %) patients after subtotal parathyroidectomy and 2/29 (6.9 %) subjects after incomplete parathyroidectomy (p = 0.006). Transient recurrent laryngeal nerve paresis occurred in 14/594 (2.4 %) and permanent in 5/594 (0.8 %) nerves at risk.
Subtotal parathyroidectomy is a safe and efficacious treatment for patients with rHPT. Utilization of intraoperative iPTH assay can guide surgical exploration and improve the cure rate.
本研究旨在评估继发性肾性甲状旁腺功能亢进症（rHPT）患者的手术疗效。
这是一项回顾性队列研究。检索我院机构数据库中1995年至2014年期间接受治疗的符合条件的患者。纳入标准为首次因rHPT行甲状旁腺切除术。分析临床和随访数据以评估治愈率（主要结局）和发病率（次要结局）。
研究组包括297例患者（154例女性，年龄44.5±13.7岁，随访24.6±10.5个月），其中268例（90.2%）患者接受了甲状旁腺次全切除术，29例（9.8%）患者接受了甲状旁腺部分切除术。207例（69.7%）手术探查中采用了术中甲状旁腺激素（iPTH）检测。甲状旁腺次全切除术后12/268例（4.5%）患者持续性rHPT复发，甲状旁腺部分切除术后5/29例（17.2%）患者复发（p = 0.005）。术中采用iPTH检测的患者治愈率高于未监测患者，分别为201/207例（97.1%）和79/90例（87.8%）（p = 0.001）。297例患者中有1例（0.3%）住院期间死亡。甲状旁腺次全切除术后84/268例（31.3%）患者出现饥饿骨综合征，甲状旁腺部分切除术后2/29例（6.9%）患者出现该综合征（p = 0.006）。14/594条（2.4%）喉返神经出现短暂性麻痹，5/594条（0.8%）喉返神经出现永久性麻痹。
甲状旁腺次全切除术是治疗rHPT患者的一种安全有效的方法。术中iPTH检测可指导手术探查并提高治愈率。
