Van Den Heede Klaas, Brusselaers Nele, Almquist Martin, Riss Philipp, Raffaelli Marco, Van Slycke Sam
Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Hospital Aalst-Asse-Ninove, Aalst, Belgium.
Department of Women's and Children's Health, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf048.
Parathyroid surgery is an appropriate alternative for renal hyperparathyroidism (rHPT) in patients in whom medical therapy fails. European morbidity and outcome data for clearly defined cohorts, potentially reflecting contemporary clinical practice, remain scarce.
Data were extracted from the EUROCRINE® database on all operations for secondary rHPT between 1 January 2015 and 31 December 2021. Multivariable logistic regression analysis was used to identify risk factors for complications. Subgroup analyses were conducted for the two major surgical approaches (subtotal parathyroidectomy or total thyroidectomy with parathyroid transplantation), as well as for redo and concomitant thyroid surgery. The primary outcome was 30-day morbidity.
After excluding 324 patients, data were analysed for 1165 patients, who underwent primary surgery (859), redo surgery (135), or parathyroid surgery with concomitant (planned or unplanned) thyroid surgery (171). The postoperative complication rate was 13.8% (161 patients). Reintervention for bleeding was necessary in 22 patients (1.9%). The length of hospital stay was >1 week in 108 patients (9.8%), and was shorter in the redo parathyroidectomy than first-time parathyroidectomy group (52.0% (66) versus 36.6% (299) discharged within 2 days, respectively). No risk factors for complications could be identified in either the overall or subgroup analyses. In the case of redo surgery or primary surgery with concomitant thyroid surgery, recurrent laryngeal nerve palsy (6.7 versus 3.5%, respectively), revision surgery for bleeding (2.2 versus 1.2%, respectively), and wound infection rates (0.7 versus 0.0%, respectively) remained low.
This large European multicentre cohort study demonstrates the safety and low morbidity of parathyroid surgery for rHPT.
对于药物治疗无效的肾性甲状旁腺功能亢进症（rHPT）患者，甲状旁腺手术是一种合适的替代治疗方法。目前，关于明确界定队列的欧洲发病率和结局数据仍然稀缺，而这些数据可能反映当代临床实践。
从EUROCRINE®数据库中提取2015年1月1日至2021年12月31日期间所有继发性rHPT手术的数据。采用多变量逻辑回归分析确定并发症的危险因素。对两种主要手术方式（甲状旁腺次全切除术或甲状腺全切除术加甲状旁腺移植）以及再次手术和同期甲状腺手术进行亚组分析。主要结局为30天发病率。
排除324例患者后，对1165例患者的数据进行了分析，这些患者接受了初次手术（859例）、再次手术（135例）或同期（计划或非计划）甲状腺手术的甲状旁腺手术（171例）。术后并发症发生率为l3.8%（161例患者）。22例患者（1.9%）因出血需要再次干预。108例患者（9.8%）住院时间超过1周，再次甲状旁腺切除术组出院时间短于初次甲状旁腺切除术组（分别为52.0%（66例）和36.6%（299例）在2天内出院）。在总体或亚组分析中均未发现并发症的危险因素。在再次手术或同期甲状腺手术的初次手术中，喉返神经麻痹（分别为6.7%和3.5%）、出血翻修手术（分别为2.2%和1.2%）和伤口感染率（分别为0.7%和0.0%）仍然较低。
这项大型欧洲多中心队列研究证明了甲状旁腺手术治疗rHPT的安全性和低发病率。
