甲状旁腺全切除术加前臂移植治疗尿毒症难治性继发性甲状旁腺功能亢进

目的]研究甲状旁腺全切除术加自体前臂移植对于尿毒症引起的难治性继发性甲状旁腺功能亢进的效果.方法]总结分析本院12例因慢性肾脏疾病长期接受规律性血液透析的患者发生继发性甲状旁腺功能亢进(SHPT),因持续性高血钙及高甲状旁腺素(parathyroid hormone,PTH),药物治疗无效,予行甲状旁腺全切除术加前...

Total Parathyroidectomy and Forearm Autograft in the Treatment of Uremia with Refractory Secondary Hyperparathyroidism

Objective]To study the efficacy of total parathyroidectomy combined with forearm autograft for the treatment of refractory secondary hyperparathyroidiam（SHPT） caused by uremia. Methods]Twelve SHPT patients caused by chronic renal disease receiving long-term regular hemodialysis were analyzed. These patients underwent total parathyroidectomy and forearm autograft due to the failure of drug therapy for persistent hypercalcemia and high parathyroid hormone（PTH）. Serum PTH, calcium and clinical symptoms were compared before and after the operation. Results] No one in 12 cases died after the operation. Serum PTH in 8 cases dropped to normal level. Serum calcium in these 8 cases even dropped lower than normal level and regained normal level after calcium supplement. After the operation, serum levels of PTH and calcium decreased obviously, but were still higher than normal level in 4 cases. After surgically removing partial parathyroid gland grafted in the forearm again, serum PTH and calcium in 4 cases dropped to normal level. The incidence of postoperative hypoealcemia in all groups was the highest（66.7%, 8/ 12）. Serum calcium decreased obviously 3 week after the operation, and gradually regained normal level 6 months after the operation. Thesymptoms such as bone pain all over the body, skin pruritus, fatigue and inappetence of patients were improved obviously. Bone densitometry showed that bone mass increased obviously. Conclusion] Total parathyroidectomy and forearm autograft for the treatment of uremia with SHPT has certain efficacy, and is a safe and reliable method.