Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Front Endocrinol (Lausanne). 2023 Apr 20;14:1169793. doi: 10.3389/fendo.2023.1169793. eCollection 2023.
Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and Tc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients' need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.
继发性甲状旁腺功能亢进症（SHPT）是慢性肾脏病患者的一个主要问题，可导致许多并发症，包括骨营养不良、骨折和心血管疾病。随着钙敏感受体激动剂的出现，SHPT 的治疗发生了根本性的变化；然而，甲状旁腺切除术（PTx）仍然是最重要的治疗方法之一。为了成功进行 PTx，必须切除所有甲状旁腺（PTGs）而不产生并发症，以防止持续性或复发性 SHPT。术前用于定位 PTGs 的影像学研究，如超声、计算机断层扫描和 Tc-Sestamibi 闪烁扫描，以及用于确认切除所有 PTGs 的术中评估方法，包括术中完整甲状旁腺激素监测和冷冻切片诊断，都是有用的。术中神经监测可确认喉返神经的功能和解剖保留。可以进行全或次全 PTx 联合经颈胸腺切除术和自体移植，也可以进行。根据患者对肾移植的需求，应选择适当的 PTx 手术方法。在初始 PTx 后出现持续性或复发性 SHPT 的情况下，由于致病的 PTGs 可能存在于颈部、纵隔或自体移植区域，因此定位致病的 PTGs 并进行自体移植具有挑战性。此外，钙敏感受体激动剂和 PTx 的疗效和成本效益也越来越受到关注。在这篇综述中，描述了 SHPT 的内科和外科治疗方法。
