Total parathyroidectomy combined with partial autotransplantation for the treatment of secondary hyperparathyroidism

作     者：ZOU Qiang WANG Hong-ying ZHOU Jian LAO Zheng-yin XUE Jun LI Ming-xin LI Hai-ming JIN Yi-ting GU Yong ZHANG Yan-ling 

作者机构：Department of Surgery Huashan Hospital Shanghai Medical College Fudan University Shanghai 200040 China Department of Nephrology Huashan Hospital Shanghai Medical College Fudan University Shanghai 200040 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2007年第120卷第20期

页      面：1777-1782页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：hyperparathyroidism, secondary parathyroidectomy transplantation, autologous 

摘      要：Background Drug treatment for secondary hyperparathyroidism caused by chronic renal failure may be available at the early stage of the disease, but it is not as effective for serious patients. The aim of the study was to evaluate the effect of total parathyroidectomy combined with forearm autotransplantation in the uremic patients with secondary hyperparathyroidism. Methods From September 1999 through September 2006, parathroidectomy and autotransplantaUon was performed in 20 patients. The coherence between the results of preoperative parathyroid ultrasonography and surgical exploration were compared. The serum calcium concentration and intact parathyroid hormone （iPTH） were monitored preoperatively, intraoperatively, and postoperatively. Results A total of 71 hyperplastic parathyroid glands were resected in the 20 patients. The accordance rate of parathyroid localization between B-ultrasonography and intraoperaUve exploration was 94.4%. The average iPTH value was （110.90±67.42） ng/L, （433.80±243.72） ng/L, （48.80±42.69） ng/L, （229.04±172.68） ng/L and （232.39±224.05） ng/L at day 1, 2, 3, 7, 30 after operation respectively. The clinical symptoms were ameliorated and the levels of serum calcium concentration were controlled within the normal range after operation. Recurrent secondary hyperparathyroidism had happened in 1 case, 4 years postoperatively because of the development of autograft hyperplasia, and in another case 2 years postoperatively due to remnant of neck parathyroid glands. The clinical symptoms were all alleviated after re-operation. No surgical complication had occurred in any of the patients. Conclusions The total parathyroidectomy with forearm autotransplantation is feasible, safe, and effective for patients with secondary hyperparathyroidism in the short term. The long-term effects should be further investigated.