Albertucci M, Zielinski C M, Rothberg M, Sterpetti A, Klingman R, Ronk J F
Department of Surgery, Creighton University, Omaha, Nebraska 68131.
Surg Gynecol Obstet. 1988 Jul;167(1):49-52.
During the period from December 1984 to December 1986, ten patients with end-stage renal disease were evaluated with hyperparathyroidism refractory to medical management. Symptoms were bone pain in eight patients and pruritus and constipation in two. Two patients with bone pain also had impaired mentation. Biochemical preoperative assessment revealed calcium levels between 8.7 and 11.2 milligrams per deciliter, with a median of 10.5 milligrams per deciliter. Phosphate levels were normal in all but three patients, and the phosphate-calcium product was greater than 80 in two. Parathyroid hormone levels assessed with the radioimmunoassay method were elevated in all patients, and results of ultrasound of the neck, done in seven patients, revealed hyperplastic glands in six patients and normal glands in one patient. All patients underwent surgical exploration of the neck with removal of four parathyroid glands and immediate autotransplantation. No complications related to the operative procedure occurred. Postoperative calcium levels ranged between 6.5 and 9.5 milligrams per deciliter on the first postoperative day and normalized by the sixth day. Four patients experienced symptomatic hypocalcemia requiring intravenous calcium supplementation for one to six days postoperatively. The mean hospital stay was four days (three to seven days). All patients had histologically confirmed four gland parathyroid hyperplasia. Marked improvement of symptoms was accomplished in all patients after a period of three to 30 days. One patient required revision of the forearm parathyroid transplant after four months. One patient required calcium supplementation taken orally, two patients required 1,25-Dihydroxyvitamin D3 and five required treatment with both. Two patients did not require any further medical treatment, and no patient had recurrent symptoms after a mean follow-up period of eight months. We recommend total parathyroidectomy with autotransplantation in patients with end-stage renal disease as a safe and effective procedure for symptomatic refractory hyperparathyroidism. Symptom relief can be accomplished in the vast majority of patients.
在1984年12月至1986年12月期间，对10例终末期肾病合并药物治疗难治性甲状旁腺功能亢进的患者进行了评估。症状方面，8例患者有骨痛，2例有瘙痒和便秘。2例骨痛患者还伴有精神状态受损。术前生化评估显示，血钙水平在每分升8.7至11.2毫克之间，中位数为每分升10.5毫克。除3例患者外，其余患者血磷水平正常，2例患者的磷钙乘积大于80。采用放射免疫分析法测定的甲状旁腺激素水平在所有患者中均升高，7例患者进行了颈部超声检查，其中6例显示甲状旁腺增生，1例正常。所有患者均接受了颈部手术探查，切除4个甲状旁腺并立即进行自体移植。未发生与手术相关的并发症。术后第一天血钙水平在每分升6.5至9.5毫克之间，第六天恢复正常。4例患者出现症状性低钙血症，术后需要静脉补钙1至6天。平均住院时间为4天（3至7天）。所有患者经组织学证实为4个甲状旁腺增生。3至30天后，所有患者的症状均有明显改善。1例患者在4个月后需要对前臂甲状旁腺移植进行修复。1例患者需要口服补钙，2例患者需要1,25 - 二羟维生素D3，5例患者需要两者联合治疗。2例患者无需进一步治疗，平均随访8个月后，无患者出现复发症状。我们建议，对于终末期肾病合并症状性难治性甲状旁腺功能亢进的患者，行甲状旁腺全切并自体移植是一种安全有效的手术方法。绝大多数患者的症状能够得到缓解。
