Punch J D, Thompson N W, Merion R M
Department of Surgery, University of Michigan Medical School, Ann Arbor, USA.
Arch Surg. 1995 May;130(5):538-42; discussion 542-3. doi: 10.1001/archsurg.1995.01430050088015.
To determine long-term results and durability of parathyroidectomy in patients with chronic renal failure and renal transplant recipients.
Retrospective chart review and structured telephone interviews.
Tertiary-care academic medical center.
Ninety-one consecutive patients (80 undergoing long-term dialysis, 11 with posttransplant hyperparathyroidism). Mean follow-up was 8 years (minimum follow-up, 2 years; longest follow-up, 25 years). The most common indications for operation were bone pain (70% [56/80]) and weakness (46% [37/80]) in patients with renal failure and hypercalcemia (91% [10/11]) in renal transplant recipients.
Subtotal parathyroidectomy without remnant gland implantation.
Postoperative morbidity and mortality, relief and recurrence of symptoms.
Symptoms were successfully ameliorated in 95% (86/91) of patients. Clinically significant complications occurred in 5% (5/91) of patients (one patient each with wound hematoma, wound infection, and permanent recurrent laryngeal nerve paralysis and two patients with permanent hypoparathyroidism). Recurrence occurred in five (5%) of 91 patients. Two of these patients required four operations each to eradicate all hyperfunctioning accessory glands. The other three recurrences were caused by hyperplasia of the remnant gland left in the neck. These were easily treated by simple excision, with no morbidity. The actuarial rate of recurrent hyperparathyroidism was 4.1% at 1 year and 11.7% at 20 years. Overall hospital mortality was 3% (3/91). None of the deaths was directly attributable to parathyroidectomy.
We recommend subtotal parathyroidectomy without remnant implantation as a safe and durable intervention for hyperparathyroidism associated with renal failure and following renal transplantation. This intervention is associated with an acceptably low recurrence rate over extremely long periods of follow-up.
确定慢性肾衰竭患者和肾移植受者甲状旁腺切除术的长期效果及耐用性。
回顾性病历审查和结构化电话访谈。
三级医疗学术医学中心。
91例连续患者（80例接受长期透析，11例患有移植后甲状旁腺功能亢进）。平均随访时间为8年（最短随访时间为2年；最长随访时间为25年）。肾衰竭患者最常见的手术指征是骨痛（70%[56/80]）和虚弱（46%[37/80]），肾移植受者是高钙血症（91%[10/11]）。
次全甲状旁腺切除术，不植入残留腺体。
术后发病率和死亡率、症状缓解及复发情况。
95%（86/91）的患者症状得到成功改善。5%（5/91）的患者发生了具有临床意义的并发症（1例患者分别出现伤口血肿、伤口感染和永久性喉返神经麻痹，2例患者出现永久性甲状旁腺功能减退）。91例患者中有5例（5%）复发。其中2例患者每人需要进行4次手术以根除所有功能亢进的副腺体。另外3例复发是由颈部残留腺体增生引起的。通过简单切除很容易治疗，且无并发症。甲状旁腺功能亢进复发的精算率在1年时为4.1%，在20年时为11.7%。总体医院死亡率为3%（3/91）。没有一例死亡直接归因于甲状旁腺切除术。
我们建议次全甲状旁腺切除术不植入残留腺体，作为治疗与肾衰竭和肾移植相关的甲状旁腺功能亢进的一种安全且耐用的干预措施。在极长的随访期内，这种干预措施的复发率低至可接受程度。
