甲状旁腺切除术治疗与肾病相关的甲状旁腺功能亢进症。
Parathyroidectomy for hyperparathyroidism associated with renal disease.
作者信息
O'Leary D P, White H J
机构信息
Department of Surgery, Southmead Hospital, Bristol.
出版信息
Ann R Coll Surg Engl. 1995 Mar;77(2):97-101.
Between 1969 and 1993, 123 patients were accepted in this unit for surgery for refractory hyperparathyroidism associated with chronic renal failure. Subtotal parathyroidectomy was the procedure of choice. At operation, four or more parathyroids were identified in 75% of patients. Methylene blue localised additional parathyroids in 32% of initial explorations in which it was used. Coincidental thyroid pathology was found in 8.3%, including papillary carcinoma in 2.4%. No further parathyroid surgery was required in 90% of patients at a mean of 6.6 years after operation. Reoperation (10%) was more likely to be required (14.3%) when less than four glands were found than when four or more were found (8.5%). Patients continuing on dialysis were more likely to need reoperation than those with functioning renal transplants.
1969年至1993年间，本单位收治了123例因慢性肾衰竭伴难治性甲状旁腺功能亢进接受手术治疗的患者。甲状旁腺次全切除术是首选术式。手术时，75%的患者可发现4个或更多甲状旁腺。在32%首次探查使用亚甲蓝的病例中，亚甲蓝定位到了额外的甲状旁腺。8.3%的患者伴有甲状腺病变，其中2.4%为乳头状癌。90%的患者术后平均6.6年无需再次进行甲状旁腺手术。术中发现甲状旁腺少于4个的患者再次手术的可能性（14.3%）高于发现4个或更多甲状旁腺的患者（8.5%）。继续接受透析的患者比接受功能性肾移植的患者更有可能需要再次手术。
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