Delmonico F L, Wang C A, Rubin N T, Fang L S, Herrin J T, Cosimi A B
Ann Surg. 1984 Nov;200(5):644-7. doi: 10.1097/00000658-198411000-00015.
A subtotal parathyroidectomy was performed in 32 patients with hyperparathyroidism and renal dysfunction. Minimal long-term sequelae were observed [two patients with recurrent hyperparathyroidism (6.2%), one patient with persistent hypoparathyroidism (3.1%)]. This experience is compared with reports in the literature advocating total parathyroidectomy and autotransplantation. A subtotal parathyroidectomy remains the preferred approach at this institution. Patients with elevated alkaline phosphatase levels before surgery should be monitored carefully for early postoperative hypocalcemia. The low incidence (3.2%) of hyperparathyroidism observed in patients following successful renal transplantation indicates that hypercalcemic allograft recipients should be observed for at least 4 months before contemplating surgical intervention.
对32例甲状旁腺功能亢进合并肾功能不全患者实施了甲状旁腺次全切除术。观察到的长期后遗症极少[2例复发性甲状旁腺功能亢进（6.2%），1例持续性甲状旁腺功能减退（3.1%）]。将该经验与文献中主张甲状旁腺全切除术及自体移植的报告进行了比较。甲状旁腺次全切除术仍是本机构的首选方法。术前碱性磷酸酶水平升高的患者术后应密切监测早期低钙血症情况。肾移植成功的患者中观察到的甲状旁腺功能亢进发生率较低（3.2%），这表明对于移植后高钙血症患者，在考虑手术干预前应观察至少4个月。
