Sivula A, Kuhlbäck B, Kock B, Kahri A, Wallenius M, Edgren J
Acta Chir Scand. 1979;145(1):19-25.
During the period 1971-1976, subtotal parathyroidectomy was performed on 34 patients with chronic renal failure, representing 8% of all uraemic patients treated on the Renal Ward. Preoperative treatment of renal failure was conservative therapy in 6, haemodialysis in 20 and renal transplantation in 8 patients. The operation was indicated by grave clinical symptoms (pruritus, bone pains and mental disturbances), gastric ulcer and radiological abnormalities (osteoporosis, fractures, subperiosteal resorption and metastatic calcifications). The serum immunoreactive parathyroid hormone was determined in 13 cases, and the value was elevated in all. The serum calcium level was elevated in 8 out of 34 cases. Less than 500 mg of parathyroid tissue was removed in 12 cases, between 500 and 6000 mg in 19 and over 6000 mg in 3. Nodular hyperplasia was present in 11 patients, diffuse hyperplasia in 23. Postoperatively marked falls in serum parathyroid hormone and serum calcium values were observed. The bone pains, pruritus and mental disturbances were alleviated, and the general condition was favourably influenced. The operation had a lesser and more retarded effect on the radiological changes. Complete recovery was only achieved with successful renal transplant. Parathyroidectomy often had a favourable effect on the grave symptoms and may, therefore, be considered in some cases of severe hyperparathyroidism secondary to chronic renal failure.
1971年至1976年期间，对34例慢性肾衰竭患者实施了甲状旁腺次全切除术，占肾病病房所有尿毒症患者的8%。6例肾衰竭患者术前采用保守治疗，20例采用血液透析，8例接受肾移植。手术指征为严重的临床症状（瘙痒、骨痛和精神障碍）、胃溃疡以及放射学异常（骨质疏松、骨折、骨膜下吸收和转移性钙化）。13例患者测定了血清免疫反应性甲状旁腺激素，所有患者该值均升高。34例中有8例血清钙水平升高。12例切除的甲状旁腺组织少于500mg，19例在500至6000mg之间，3例超过6000mg。11例患者存在结节性增生，23例为弥漫性增生。术后观察到血清甲状旁腺激素和血清钙值显著下降。骨痛、瘙痒和精神障碍得到缓解，总体状况受到有利影响。手术对放射学改变的影响较小且较迟缓。只有成功进行肾移植才能完全康复。甲状旁腺切除术通常对严重症状有良好效果，因此，在某些慢性肾衰竭继发严重甲状旁腺功能亢进的病例中可以考虑实施该手术。
