[Clinical studies on surgical treatment of renal hyperparathyroidism].

While patients of chronic renal failure can survive today for a long period thanks to the spread of hemodialysis, establishment of criteria for the treatment of renal hyperparathyroidism is an important problem. In the 15 cases of renal hyperparathyroidism previously operated by the author, preoperative examinations and findings at the time of operation, and technique of operation and postoperative examinations were analyzed together with the effects of operation, and the indications and technique of operation were discussed. Surgical indication Since the histological findings of resected parathyroids presented chief cell hyperplasia in the whole gland and coexistence of fat tissues was hardly recognized, it was estimated that the weight of parathyroid glands directly reflected the secretory function of the parathyroid glands. Accordingly, the relation between the preoperative findings and weight of parathyroid glands was analyzed. As a result, a significant correlation was noted between the preoperative c-PTH and the weight of parathyroid glands. Hence it was proved possible to predict the approximate weight of parathyroid glands from the preoperative level of c-PTH. Further investigations were made on s-Al-P, s-CT, RMC, roentgenographic findings, ca-infusion test, iliac bone biopsy, subjective symptoms, and weight of parathyroid glands, and the following conclusions were obtained with respect to the surgical indication. 1) When the weight of parathyroid glands was estimated to be above 2000 mg, the operation would be an absolute indication. 2) If the weight is estimated between 1000 and 2000 mg, the operation should be preferred because the improvement by conservative treatment may not be expected. 3) In the case of slight swelling of less than 1000 mg, the first choice of treatment should be conservative. However the operation in the early stage would be essential in the case of calcification of the blood vessel wall. Surgical technique In 10 of the 15 cases operated, subtotal parathyroidectomy was performed. For longer period than 6 months after surgery clinical study was performed with respect to the changes in c-PTH, s-Al-P, CT, RMC, bone roentgenographic findings, s-Ca, s-P, iliac bone biopsy, and subjective symptoms. As a result, the postoperative course was good in patients in whom the subtotal parathyroidectomy was performed with 20 to 50 mg of the remaining parathyroid tissue. The value of c-PTH was stabilized in 3 months after the operation, and was thereafter controlled within normal ranges. In view of the possibility of the recurrence, the desirable weight of the remaining parathyroid tissue would be 20 to 30 mg.(ABSTRACT TRUNCATED AT 400 WORDS)