TREATMENT OF SECONDARY HYPERPARATHYROIDISM IN PATIENTS WITH CHRONIC-RENAL-FAILURE BY TOTAL PARATHYROIDECTOMY AND PARATHYROID AUTOGRAFT
TREATMENT OF SECONDARY HYPERPARATHYROIDISM IN PATIENTS WITH CHRONIC-RENAL-FAILURE BY TOTAL PARATHYROIDECTOMY AND PARATHYROID AUTOGRAFT
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DOI：
10.1097/00000658-198106000-00014
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发表时间：
1981-01-01
影响因子：
9
通讯作者：
ROSTAND, SG
中科院分区：
文献类型：
--
作者：
DIETHELM, AG;ADAMS, PL;ROSTAND, SG
对61例慢性肾功能衰竭继发性甲状旁腺功能亢进症患者进行了甲状旁腺全切除和自体甲状旁腺移植。甲状旁腺切除术缓解的症状包括骨痛、瘙痒、软组织钙化、肌肉无力和骨折愈合。48例患者手术前后测定血清甲状旁腺激素水平，除2例外，其余均恢复正常。除1例甲状旁腺残留外，术后血清碱性磷酸酶水平也恢复正常。61例患者中有30例在手术前后进行了完整的放射学检查。24例纤维性骨炎患者中有23例有愈合的证据，其中一例没有变化。骨硬化症23例，8例轻微改善，14例无变化，1例恶化。病理检查发现弥漫性增生45例，结节状增生16例。术后前30天有2例早期死亡，术后4个月至4年有16例晚期死亡。在任何情况下，手术都不会导致死亡。有些病人术后需要补钙，但没有发生严重的低钙血症。无复发甲状旁腺功能亢进症。图片
Sixty-one patients with chronic renal failure and secondary hyperparathyroidism underwent total parathyroidectomy and parathyroid autograft. Symptoms relieved by parathyroidectomy included bone pain, pruritus, soft tissue calcification, muscle weakness and healing of fractures. Serum parathormone levels measured before and after operation in 48 patients returned to normal in all but two patients. Serum alkaline phosphatase levels also returned toward normal after operation, except in one patient with a retained parathyroid gland. Complete radiographic studies before and after operation were available in 30 of 61 patients. Twenty-three of 24 patients with osteitis fibrosa had evidence of healing, and in one patient no change occurred. Osteosclerosis noticed in 23 patients improved slightly in eight patients, did not change in 14 and became worse in one. Pathologic examinations revealed 45 patients to have diffuse hyperplasia and 16 nodular hyperplasia. There were two early postoperative deaths, in the first 30 days, and 16 late postoperative deaths, from four months to four years afterward. In no case did the operation contribute to death. Some patients required the administration of supplemental calcium after operation, but in no instance did profound hypocalcemia occur. No patient developed recurrent hyperparathyroidism. Images