Koonsman M, Hughes K, Dickerman R, Brinker K, Dunn E
Department of Surgery, Methodist Medical Center, Dallas, Texas.
Am J Surg. 1994 Dec;168(6):631-4; discussion 634-5. doi: 10.1016/s0002-9610(05)80135-7.
A subset of patients who are being maintained on dialysis for end-stage renal disease develop severely symptomatic secondary hyperparathyroidism that cannot be controlled medically. The relative merits of two alternative surgical approaches--subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation--have not been clearly elucidated.
The records of 77 patients who had renal failure and underwent parathyroid surgery between 1982 and 1993 were retrospectively reviewed.
Fifty-three patients (69%) underwent subtotal parathyroidectomy and 24 (31%) underwent total resection with auto-transplantation into forearm musculature. The incidences of postoperative hypocalcemia and tetany were similar in both groups, as was the recurrence rate (7%) of clinically significant hyperparathyroidism.
Subtotal parathyroidectomy can be performed without mortality or morbidity and provides good control of hyperparathyroidism secondary to chronic renal failure. Total parathyroidectomy with autotransplantation offers no additional advantage in this difficult patient population. Most patients will require postoperative intravenous calcium replacement. We observed a significant incidence of continued hyperparathyroidism following successful renal transplantation.
一部分接受终末期肾病透析治疗的患者会出现严重的症状性继发性甲状旁腺功能亢进，药物无法控制。两种替代手术方法——甲状旁腺次全切除术与甲状旁腺全切除术加自体移植——的相对优点尚未明确阐明。
回顾性分析1982年至1993年间77例肾衰竭并接受甲状旁腺手术患者的记录。
53例患者（69%）接受了甲状旁腺次全切除术，24例（31%）接受了全切除术并自体移植至前臂肌肉组织。两组术后低钙血症和手足抽搐的发生率相似，具有临床意义的甲状旁腺功能亢进复发率（7%）也相似。
甲状旁腺次全切除术可在无死亡或并发症的情况下进行，并能很好地控制慢性肾衰竭继发的甲状旁腺功能亢进。对于这一困难的患者群体，甲状旁腺全切除术加自体移植并无额外优势。大多数患者术后需要静脉补钙。我们观察到肾移植成功后仍有显著比例的患者甲状旁腺功能亢进持续存在。
