Surgical indications and procedures of parathyroidectorny in patients with chronic kidney disease
Surgical indications and procedures of parathyroidectorny in patients with chronic kidney disease
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DOI：
10.1111/j.1774-9987.2005.00213.x
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发表时间：
2005-02-01
影响因子：
1.9
通讯作者：
Sato, T
中科院分区：
文献类型：
--
作者：
Tominaga, Y;Matsuoka, S;Sato, T
美国肾脏基金会为包括甲状旁腺切除术(PTX)在内的慢性肾脏疾病的骨代谢和疾病提出了临床实践指南。我们对1725例晚期继发性甲状旁腺功能亢进症(2HPT)患者进行了PTX治疗，评估了PTX的K/DOQI指南，并与我们的手术策略进行了比较。指南强调避免异位钙化和心血管并发症，这可能是由高钙血症、高磷血症和持续的高甲状旁腺激素水平引起的。我们同意K/DOQI指南的态度。在决定手术适应证时，我们强调甲状旁腺的大小是重要的因素之一。指南建议采用次全PTX和全PTX联合自体移植。我们倾向于全PTX加前臂自体移植，主要是因为与颈部再探查相比，在复发时切除前臂残留的甲状旁腺组织更容易、更安全。在日本，几乎所有患者在PTX后都需要长期血液透析，因为肾移植的机会非常小。复发的风险是不容忽视的。基于我们丰富的经验，我们相信我们的治疗晚期继发性甲状旁腺功能亢进的策略至少在日本是可以接受的。
The Kidney Foundation of the USA proposed clinical practice guidelines for bone metabolism and disease in chronic kidney disease including parathyroidectomy (PTx). We performed PTx in a total of 1725 patients with advanced secondary hyperparathyroidism (2HPT) and evaluated the K/DOQI guideline concerning PTx, comparing it with our surgical strategy. The guidelines emphasize the avoidance of ectopic calcification and cardiovascular complications which may be induced by hypercalcemia, hyperphosphatemia, and persistent high parathyroid hormone level. We agree with the attitude of the K/DOQI guideline. To decide surgical indications, we emphasize that the size of parathyroid gland is one of the important factors. The guideline recommends subtotal PTx and total PTx with autotransplantation. We prefer total PTx with forearm autograft, mainly because it is easier and safer to remove the residual parathyroid tissue from the forearm at recurrence compared to neck re-exploration. In Japan, almost all patients require long-term hemodialysis after PTx because of the very small opportunity of kidney transplantation. The risk of recurrence is not negligible. Based on our huge experience we believe our strategy for advanced secondary hyperparathyroidism can be accepted at least in Japan.