Max M H, Flint L M, Richardson J D, Ferris F Z, Nagar D
Surg Gynecol Obstet. 1981 Aug;153(2):177-80.
Sixteen patients with chronic renal failure underwent total parathyroidectomy and parathyroid autotransplantation into the muscle of the forearm. Pertinent preoperative medical history of these patients included renal osteodystrophy, metastatic vascular calcifications, intractable itching and uncontrollable hyperphosphatemia. Efforts to control preoperative serum calcium and elevated serum parathormone levels were unsuccessful. The mass of parathyroid tissue implanted, in most instances, was approximately half that used in other series. Postoperatively, all patients received vitamin D and calcium orally, which were gradually decreased. Fourteen of the 16 patients had relief of symptoms, and all had restoration of parathormone levels to normal or slightly above normal, although in two patients, partial excision of hyperfunctioning tissue from the forearm was subsequently required because of recurring symptoms of secondary hyperparathyroidism. All patients had evidence of functioning grafts six to 40 months postoperatively or until death, attributable to intercurrent causes. The success of total parathyroidectomy and parathyroid autotransplantation in patients with chronic renal failure and symptomatic secondary hyperparathyroidism makes this a viable approach to the disease in such patients.
16例慢性肾衰竭患者接受了甲状旁腺全切术，并将甲状旁腺自体移植至前臂肌肉。这些患者术前的相关病史包括肾性骨营养不良、转移性血管钙化、顽固性瘙痒和难以控制的高磷血症。控制术前血清钙和升高的血清甲状旁腺激素水平的努力均未成功。在大多数情况下，植入的甲状旁腺组织量约为其他系列所用组织量的一半。术后，所有患者口服维生素D和钙剂，并逐渐减量。16例患者中有14例症状缓解，所有患者的甲状旁腺激素水平均恢复至正常或略高于正常，尽管有2例患者因继发性甲状旁腺功能亢进症状复发，随后需要从前臂切除部分功能亢进的组织。所有患者在术后6至40个月或直至因并发其他原因死亡时，均有移植组织功能良好的证据。甲状旁腺全切术和甲状旁腺自体移植对于慢性肾衰竭合并有症状的继发性甲状旁腺功能亢进患者取得了成功，使其成为治疗此类患者疾病的一种可行方法。
