Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Department of Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA.
Ann Surg. 2022 Sep 1;276(3):e141-e176. doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18.
To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism.
Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT.
Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content.
These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation.
Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.
为继发性（SHPT）和 tertiary（THPT）甲状旁腺功能亢进症的安全、有效和适当治疗制定循证推荐。
甲状旁腺功能亢进症在慢性肾脏病、终末期肾脏病和肾移植患者中很常见。SHPT 和 THPT 的手术管理很复杂，需要多学科方法。目前尚无针对 SHPT 和 THPT 手术治疗的临床实践指南。
由 10 名 SHPT 和 THPT 专家组成的小组对 1985 年 1 月 1 日至 2021 年 1 月 1 日的医学文献进行了回顾。使用最佳现有证据构建推荐意见。使用美国医师学院分级系统确定证据水平。讨论推荐意见以达成共识。美国内分泌外科学会会员审查并评论了内容的初稿。
这些临床指南介绍了 SHPT 和 THPT 的流行病学和病理生理学，并为所有相关临床医生提供了 SHPT 和 THPT 的检查和管理建议。它概述了 SHPT 和 THPT 的术前、术中及术后管理，以及相关定义、手术技术、发病率和结果。具体主题包括发病机制和流行病学、初始评估、影像学、术前和围手术期护理、手术计划和甲状旁腺切除术、辅助和方法、结果和再次手术。
制定循证指南是为了帮助临床医生优化继发性和 tertiary 甲状旁腺功能亢进症的管理。
