Fletcher S, Kanagasundaram N S, Rayner H C, Irving H C, Fowler R C, Brownjohn A M, Turney J H, Will E J, Davison A M
Renal Unit, Leeds General Infirmary, UK.
Nephrol Dial Transplant. 1998 Dec;13(12):3111-7. doi: 10.1093/ndt/13.12.3111.
Tertiary hyperparathyroidism continues to cause significant morbidity in patients with chronic renal failure. This is frequently resistant to medical management and may ultimately require a surgical parathyroidectomy. Recent studies have reported upon the technique of percutaneous ethanol ablation for both primary and tertiary hyperparathyroidism. In this study we report on a 5 year experience using ethanol injection and compare the results with surgical parathyroidectomy.
A prospective study in 39 patients with tertiary hyperparathyroidism, 25 were dialysis dependent and 14 had a functioning renal allograft. Twenty-two patients underwent percutaneous fine needle ethanol injection (PFNEI) and 17 underwent surgical parathyroidectomy.
A > 30% reduction in intact parathyroid hormone (iPTH) was achieved in 11 of 22 patients undergoing PFNEI after a mean of 1.8 +/- 1.4 injections per gland. In four patients, symptomatic hyperparathyroidism recurred and they required further PFNEI or surgical parathyroidectomy at 17, 28, 46, and 48 months later. There was no significant reduction in iPTH in 11 patients following PFNEI after a mean of 2.5 +/- 1.3 injections per gland. They all required a subsequent surgical parathyroidectomy for symptomatic hyperparathyroidism. Four patients developed a laryngeal nerve palsy following PFNEI, two of which were permanent. Seventeen patients underwent successful surgical parathyroidectomy as a primary procedure.
Whilst PFNEI is successful in primary hyperparathyroidism, when typically only one adenoma is present, the effectiveness of PFNEI is unpredictable and the long term results are poor compared with those of surgical parathyroidectomy in tertiary hyperparathyroidism. The procedure is not without complications and makes subsequent surgery more difficult. Therefore it can only be recommended for patients with a known single parathyroid gland such as patients in whom hyperparathyroidism has recurred following a previous surgical subtotal parathyroidectomy and who are unsuitable for further surgery.
在慢性肾衰竭患者中，三发性甲状旁腺功能亢进症持续导致显著的发病率。这通常对药物治疗有抵抗性，最终可能需要进行甲状旁腺切除术。最近的研究报道了经皮乙醇消融治疗原发性和三发性甲状旁腺功能亢进症的技术。在本研究中，我们报告了5年使用乙醇注射的经验，并将结果与甲状旁腺切除术进行比较。
对39例三发性甲状旁腺功能亢进症患者进行前瞻性研究，其中25例依赖透析，14例有功能正常的同种异体肾移植。22例患者接受经皮细针乙醇注射（PFNEI），17例接受甲状旁腺切除术。
22例接受PFNEI的患者中，平均每个腺体注射1.8±1.4次后，11例患者的完整甲状旁腺激素（iPTH）降低了30%以上。4例患者症状性甲状旁腺功能亢进复发，分别在17、28、46和48个月后需要进一步的PFNEI或甲状旁腺切除术。11例接受PFNEI的患者，平均每个腺体注射2.5±1.3次后，iPTH没有显著降低。他们都因症状性甲状旁腺功能亢进而需要随后进行甲状旁腺切除术。4例患者在PFNEI后出现喉返神经麻痹，其中2例为永久性麻痹。17例患者作为初次手术成功进行了甲状旁腺切除术。
虽然PFNEI在原发性甲状旁腺功能亢进症（通常仅存在一个腺瘤）中是成功的，但在三发性甲状旁腺功能亢进症中，PFNEI的有效性不可预测，与甲状旁腺切除术相比，长期效果较差。该手术并非没有并发症，并且会使后续手术更加困难。因此，仅推荐给已知有单个甲状旁腺的患者，例如先前进行甲状旁腺次全切除术后甲状旁腺功能亢进复发且不适合进一步手术的患者。
