MetroHealth Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
MetroHealth Medical Center, Cleveland, OH.
Surgery. 2021 Mar;169(3):513-518. doi: 10.1016/j.surg.2020.08.007. Epub 2020 Sep 9.
The aims of this study were to determine the rate of ectopic and supernumerary parathyroid glands and the outcome of surgical therapy in patients with refractory renal hyperparathyroidism.
A retrospective review of all patients who underwent parathyroidectomy for refractory renal hyperparathyroidism was completed. Operative and pathology reports were reviewed, and the number and location of resected parathyroid glands, patient outcomes, and follow-up were determined.
During the period 1993-2019, a total of 68 patients underwent subtotal or total parathyroidectomy for renal hyperparathyroidism. Of those, 59 patients (87%) were on dialysis for an average of 6.7 years. We determined that 18 patients (26%) had 24 ectopic parathyroid glands, including 9 (13%) patients with 11 supernumerary glands. A total of 2 patients had a supernumerary gland in a normal anatomic location. Of the 24 ectopic glands, 14 (58%) were in the thymus. After parathyroidectomy, 4 patients (5.9%) had persistent hyperparathyroidism, 6 patients (8.8%) developed recurrent hyperparathyroidism, and 2 patients (3%) had permanent hypoparathyroidism.
Ectopic and supernumerary parathyroid glands occurred in 26% and 16% of patients with renal hyperparathyroidism, respectively, and the thymus was the most common location. Thorough neck exploration and transcervical thymectomy are important to help reduce persistent and recurrent hyperparathyroidism after parathyroidectomy for renal hyperparathyroidism.
本研究旨在确定难治性肾性甲状旁腺功能亢进症患者异位和多余甲状旁腺的发生率以及手术治疗的结果。
对所有接受难治性肾性甲状旁腺功能亢进症甲状旁腺切除术的患者进行了回顾性研究。回顾了手术和病理报告，并确定了切除的甲状旁腺数量和位置、患者结局和随访情况。
在 1993 年至 2019 年期间，共有 68 例患者因肾性甲状旁腺功能亢进症接受了甲状旁腺次全或全切除术。其中 59 例（87%）患者平均接受透析治疗 6.7 年。我们确定有 18 例（26%）患者有 24 个异位甲状旁腺，其中 9 例（13%）患者有 11 个多余腺体。共有 2 例患者的多余腺体位于正常解剖位置。在 24 个异位腺体中，14 个（58%）位于胸腺。甲状旁腺切除术后，4 例（5.9%）患者持续性甲状旁腺功能亢进，6 例（8.8%）患者复发性甲状旁腺功能亢进，2 例（3%）患者永久性甲状旁腺功能减退。
在肾性甲状旁腺功能亢进症患者中，异位和多余甲状旁腺的发生率分别为 26%和 16%，胸腺是最常见的位置。彻底的颈部探查和经颈胸腺切除术对于减少肾性甲状旁腺功能亢进症甲状旁腺切除术后持续性和复发性甲状旁腺功能亢进症非常重要。
