2022版美国内分泌外科医师协会《继发性及三发性甲状旁腺功能亢进症确定性外科治疗指南》外科部分解读

随着透析患者的持续增加及透析时间增长，慢性肾脏病（CKD）相关的继发性甲状旁腺功能亢进（SHPT）发病率持续增加，需要外科干预的患者人数也随之增加。美国内分泌外科医师协会（AAES）于2022年发布了首版《继发性及三发性甲状旁腺功能亢进确定性外科治疗指南》。指南基于大量循证医学研究，规范了SHPT及三发性甲状旁腺功能亢进（THPT）的外科治疗指征，系统对比了不同手术方式的优缺点，特别是对术后复发患者的再次手术治疗做出了介绍。但由于缺乏足够的RCT研究结论，该指南的部分推荐循证医学等级较低。笔者重点针对指南中肾衰性SHPT的相关外科部分进行解读，旨在帮助临床医生更深入地掌握SHPT的临床管理，促使诊疗进一步规范化。

Interpretation of the surgery section of the American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism (2022)

With the continuous increase of dialysis patients and the prolongation of dialysis time, the prevalence of chronic kidney disease (CKD) related secondary hyperparathyroidism (SHPT) is rising, and so is the number of patients requiring surgical intervention. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism was developed in 2022. Based on evidence-based medicine, the guidelines standardized the surgical indications for SHPT and tertiary hyperparathyroidism (THPT), with a systematic comparison of the strengths and weaknesses of different surgical approaches, and fully introduced the reoperation for patients with postoperative recurrence. However, due to the lack of RCT data, the evidence levels of some recommendations of the guidelines are relatively low. Here, the authors emphatically interpret the relevant surgery parts of the guidelines for SHPT due to renal failure, aiming to assist surgeons in further deepening their knowledge in the management of SHPT and promoting the standardization of its diagnosis and treatment.