Rothmund M, Wagner P K
Ann Surg. 1983 Jan;197(1):7-16.
From 1975 to 1981 total parathyroidectomy and parathyroid autotransplantation were carried out in 62 patients for renal (secondary) hyperparathyroidism. The paper reports on 46 patients followed for one to six years (mean 2.2 +/- 1.2 years). Forty-one were on chronic hemodialysis, three were predialytic, two had a functioning renal graft. There have been two different groups of indications: one in which hypercalcemia was the main reason for surgery (59%), the other in which severe renal osteopathy (bone pain, radiologic and histologic signs, elevation of alkaline phosphatase, and parathyroid hormone) was observed. Among 45 patients not previously operated on for hyperparathyroidism, five parathyroid glands were removed in three patients, four glands were removed in 36 patients, and three glands were removed in five patients. In one patient previously operated (thyroid surgery), two glands were removed. Tissue was immediately autografted into a forearm muscle. One patient (two glands removed) received a cryopreserved tissue six months after neck exploration. An improvement of bone pain, pruritus, and radiologic signs of renal osteopathy was noted in about 80% of patients. At one to six years no patient was hypercalcemic, in 44 patients the grafted tissue was functioning normally after an average time of 5.8 +/- 1.4 months. One patient is still on low-dose, supplemental therapy for slight hypocalcemia 14 months after autotransplantation. In another patient a part of the grafted tissue was removed for increasing parathyroid hormone levels. Serum concentration of alkaline phosphatase and serum parathyroid hormone decreased after surgery. One- to six-year results after total parathyroidectomy and autotransplantation for renal hyperparathyroidism are considered to be extremely satisfactory.
1975年至1981年期间，对62例肾性（继发性）甲状旁腺功能亢进患者实施了甲状旁腺全切术及甲状旁腺自体移植术。本文报告了46例随访1至6年（平均2.2±1.2年）的患者情况。其中41例患者接受慢性血液透析，3例处于透析前阶段，2例拥有功能正常的肾移植。存在两组不同的手术指征：一组以高钙血症为手术的主要原因（59%），另一组则观察到严重的肾性骨病（骨痛、放射学及组织学征象、碱性磷酸酶及甲状旁腺激素升高）。在45例此前未因甲状旁腺功能亢进接受手术的患者中，3例患者切除了5个甲状旁腺，36例患者切除了4个甲状旁腺，5例患者切除了3个甲状旁腺。1例曾接受过手术（甲状腺手术）的患者切除了2个甲状旁腺。组织随即被自体移植至前臂肌肉。1例患者（切除了2个甲状旁腺）在颈部探查6个月后接受了冷冻保存的组织移植。约80%的患者骨痛、瘙痒及肾性骨病的放射学征象得到改善。在1至6年的随访期内，无患者出现高钙血症，44例患者移植组织在平均5.8±1.4个月后功能正常。1例患者在自体移植14个月后仍因轻度低钙血症接受小剂量补充治疗。另1例患者因甲状旁腺激素水平升高切除了部分移植组织。术后血清碱性磷酸酶及血清甲状旁腺激素浓度降低。甲状旁腺全切术及自体移植术治疗肾性甲状旁腺功能亢进1至6年的结果被认为极其令人满意。
