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中华肾病研究电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 166 -169. doi: 10.3877/cma.j.issn.2095-3216.2021.03.009

综述

继发性甲状旁腺功能亢进症术后复发的防治
李丹1, 谢坤2, 陈倩倩3, 刘昌华4,()   
  1. 1. 116000 大连医科大学研究生院;225001 扬州,江苏省苏北人民医院肾脏内科
    2. 410013 长沙,中南大学湘雅医学院;225001 扬州,江苏省苏北人民医院肾脏内科
    3. 225000 扬州大学临床医学院;225001 扬州,江苏省苏北人民医院肾脏内科
    4. 225001 扬州,江苏省苏北人民医院肾脏内科
  • 收稿日期:2020-10-16 出版日期:2021-06-28
  • 通信作者: 刘昌华

Prevention and treatment of postoperative recurrence of secondary hyperparathyroidism

Dan Li1, Kun Xie2, Qianqian Chen3, Changhua Liu4,()   

  1. 1. Dalian Medical University Graduate School of Medicine, Dalian 116000, Liaoning Province; Department of Nephrology, Jiangsu Provincial Subei People' s Hospital, Yangzhou 225001, Jiangsu Province; China
    2. Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province; Department of Nephrology, Jiangsu Provincial Subei People' s Hospital, Yangzhou 225001, Jiangsu Province; China
    3. Yangzhou University School of Clinical Medicine, Yangzhou 225000, Jiangsu Province; Department of Nephrology, Jiangsu Provincial Subei People' s Hospital, Yangzhou 225001, Jiangsu Province; China
    4. Department of Nephrology, Jiangsu Provincial Subei People' s Hospital, Yangzhou 225001, Jiangsu Province; China
  • Received:2020-10-16 Published:2021-06-28
  • Corresponding author: Changhua Liu
引用本文:

李丹, 谢坤, 陈倩倩, 刘昌华. 继发性甲状旁腺功能亢进症术后复发的防治[J]. 中华肾病研究电子杂志, 2021, 10(03): 166-169.

Dan Li, Kun Xie, Qianqian Chen, Changhua Liu. Prevention and treatment of postoperative recurrence of secondary hyperparathyroidism[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2021, 10(03): 166-169.

随着慢性肾衰竭患者寿命的延长,60%以上的患者会出现继发性甲状旁腺功能亢进症(SHPT),主要表现为高甲状旁腺激素水平(PTH)、钙磷代谢紊乱、骨折及心血管事件等。随着医学进展,虽然口服药物及透析方案的改善可缓解SHPT的进展,但部分患者最终需行甲状旁腺切除术(PTX)。PTX是SHPT重要的治疗措施,但部分患者术后仍然存在持续性或复发性甲状旁腺功能亢进,给患者生理及心理造成极大损害。术后复发主要原因是初次手术不充分遗漏多余腺体,或者自体移植腺体过度增生,最终导致甲状旁腺功能亢进复发,成为目前PTX术后治疗重点与难点。本文进行了对有关如何减少初次手术后SHPT复发相关文献的检索和复习,旨在提高SHPT术后复发的防治。

As the life expectancy of patients with chronic renal failure increases, more than 60% of them develop secondary hyperparathyroidism (SHPT), which is mainly manifested as high parathyroid hormone (PTH), calcium and phosphorus metabolism disorders, fractures, and cardiovascular events. With the advancement of medicine, the improvements in oral medications and dialysis protocols can alleviate the progression of SHPT, but some patients eventually still need to undergo parathyroidectomy (PTX). Although PTX is an important treatment measure for SHPT, some patients still suffer from persistent or recurrent hyperparathyroidism after surgery, which can cause devastating physical and psychological effects on the patients. The most common cause of postoperative recurrence of SHPT is the incomplete removal of the excess glands in the initial operation, or the excessive proliferation of the autologous transplanted gland, eventually leading to the recurrence of SHPT, which has become the current focus and difficulty of treatment after PTX. This article conducted a search and review of relevant literature on how to reduce the recurrence of SHPT after the initial operation, with an aim to improve the prevention and treatment of recurrence of SHPT after PTX.

[1]
Kalantar-Zadeh K, Kuwae N, Regidor DL, et al. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients [J]. Kidney Int, 2006, 70(4): 771-780.
[2]
Tentori F, Wang M, Bieber BA, et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study [J]. Clin J Am Soc Nephro, 2015, 10(1): 98-109.
[3]
Susantitaphong P, Vadcharavivad S, Susomboon T, et al. The effectiveness of cinacalcet: a randomized, open label study in chronic hemodialysis patients with severe secondary hyperparathyroidism [J]. Ren Fail, 2019, 41(1): 326-333.
[4]
Fukagawa M, Yokoyama K, Shigematsu T, et al. A phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of etelcalcetide (ONO-5163/AMG 416), a novel intravenous calcimimetic, for secondary hyperparathyroidism in Japanese haemodialysis patients [J]. Nephrol Dial Transpl, 2017, 32(10): 1723-1730.
[5]
Giordano A, Rubello D, Casara D. New trends in parathyroid scintigraphy [J]. Eur J Nucl Med, 2001, 28(9): 1409-1420.
[6]
Fraser WD. Hyperparathyroidism [J]. Lancet, 2009, 374(9684): 145-158.
[7]
Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease [J]. Kidney Int, 2007, 71(1): 31-38.
[8]
Mizobuchi M, Ogata H, Koiwa F. Secondary hyperparathyroidism: pathogenesis and latest treatment [J]. Ther Apher Dial, 2019, 23(4): 309-318.
[9]
Tominaga Y, Sato K, Tanaka Y, et al. Histopathology and pathophysiology of secondary hyperparathyroidism due to chronic renal failure [J]. Clin Nephrol, 1995, 44(Suppl 1): S42-S47.
[10]
Roth SI, Marshall RB. Pathology and ultrastructure of the human parathyroid glands in chronic renal failure [J]. Arch Intern Med, 1969, 124(4): 397-407.
[11]
Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism [J]. World J Surg, 2012, 36(2): 318-326.
[12]
Moe SM, Chertow GM, Coburn JW, et al. Achieving NKF-K/DOQI bone metabolism and disease treatment goals with cinacalcet HCl [J]. Kidney Int, 2005, 67(2): 760-771.
[13]
Madorin C, Owen RP, Fraser WD, et al. The surgical management of renal hyperparathyroidism [J]. Eur Arch Otorhinolaryngol, 2012, 269(6): 1565-1576.
[14]
Schneider R, Bartsch DK. Role of surgery in the treatment of renal secondary hyperparathyroidism [J]. Brit J Surg, 2015, 102(4): 289-290.
[15]
Chen J, Jia X, Kong X, et al. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: a systematic review and meta-analysis [J]. Nephrology (Carlton), 2017, 22(5): 388-396.
[16]
Anderson K, Ruel E, Adam MA, et al. Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes [J]. Am J Surg, 2017, 214(5): 914-919.
[17]
Tominaga Y, Kakuta T, Yasunaga C, et al. Evaluation of parathyroidectomy for secondary and tertiary hyperparathyroidism by the Parathyroid Surgeons' Society of Japan [J]. Ther Apher Dial, 2016, 20(1): 6-11.
[18]
Strambu V, Bratucu M, Garofil D, et al. The value of imaging of the parathyroid glands in secondary hyperparathyroidism [J]. Chirurgia (Bucur), 2019, 114(5): 541-549.
[19]
Coakley AJ, Kettle AG, Wells CP, et al. 99Tcm sestamibi--a new agent for parathyroid imaging [J]. Nucl Med Commun, 1989, 10(11): 791-794.
[20]
Mitchell BK, Kinder BK, Merrell RC. Localization studies in patients with hyperparathyroidism [J]. Surg Clin North Am, 1995, 75(3): 483-498.
[21]
Greenspan BS, Dillehay G, Intenzo C, et al. SNM practice guideline for parathyroid scintigraphy 4.0 [J]. J Nucl Med Technol, 2012, 40(2): 111-118.
[22]
Jiang S, Yang T, Zou Q, et al. The role of 99mTc-MIBI SPECT/CT in patients with secondary hyperparathyroidism: comparison with 99mTc-MIBI planar scintigraphy and ultrasonography [J]. BMC Med Imaging, 2020, 20(1): 115.
[23]
Pham TH, Sterioff S, Mullan BP, et al. Sensitivity and utility of parathyroid scintigraphy in patients with primary versus secondary and tertiary hyperparathyroidism [J]. World J Surg, 2006, 30(3): 327-332.
[24]
Marmin C, Toledano M, Lemaire S, et al. Computed tomography of the parathyroids: the value of density measurements to distinguish between parathyroid adenomas of the lymph nodes and the thyroid parenchyma [J]. Diagn Interv Imaging, 2012, 93(7-8): 597-603.
[25]
Liu M, Qiu N, Zha S, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for secondary hyperparathyroidism in chronic renal failure: a systematic review and meta-analysis [J]. Int J Surg, 2017, 44: 353-362.
[26]
Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism [J]. Clin J Am Soc Nephrol, 2018, 13(6): 952-961.
[27]
Yuan F, Yu W, Waqas A, et al. Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism [J]. Chin Med J (Engl), 2014, 127(13): 2413-2418.
[28]
Schneider R, Ramaswamy A, Slater EP, et al. Cryopreservation of parathyroid tissue after parathyroid surgery for renal hyperparathyroidism: does it really make sense? [J]. World J Surg, 2012, 36(11): 2598-2604.
[29]
Chen H, Wang TS, Yen TWF, et al. Operative failures after parathyroidectomy for hyperparathyroidism [J]. Ann Surg, 2010, 252(4): 691-695.
[30]
Kose E, Rudin AV, Kahramangil B, et al. Autofluorescence imaging of parathyroid glands: an assessment of potential indications [J]. Surgery, 2020, 167(1): 173-179.
[31]
Cui L, Gao Y, Yu H, et al. Intraoperative parathyroid localization with near-infrared fluorescence imaging using indocyanine green during total parathyroidectomy for secondary hyperparathyroidism [J]. Sci Rep, 2017, 7(1): 8193.
[32]
Gasparri G, Camandona M, Abbona GC, et al. Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies [J]. Ann Surg, 2001, 233(1): 65-69.
[33]
Tominaga Y, Numano M, Tanaka Y, et al. Surgical treatment of renal hyperparathyroidism [J]. Semin Surg Oncol, 1997, 13(2): 87-96.
[34]
Neyer U, Hoerandner H, Haid A, et al. Total parathyroidectomy with autotransplantation in renal hyperparathyroidism: low recurrence after intra-operative tissue selection [J]. Nephrol Dial Transpl, 2002, 17(4): 625-629.
[35]
Pattou FN, Pellissier LC, Noёl C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism [J]. World J Surg, 2000, 24(11): 1330-1334.
[36]
Schneider R, Waldmann J, Ramaswamy A, et al. Frequency of ectopic and supernumerary intrathymic parathyroid glands in patients with renal hyperparathyroidism: analysis of 461 patients undergoing initial parathyroidectomy with bilateral cervical thymectomy [J]. World J Surg, 2011, 35(6): 1260-1265.
[37]
Zhang L, Xing C, Shen C, et al. Diagnostic accuracy study of intraoperative and perioperative serum intact PTH level for successful parathyroidectomy in 501 secondary hyperparathyroidism patients [J]. Sci Rep, 2016, 6: 26841.
[38]
Moor JW, Roberts S, Atkin SL, et al. Intraoperative parathyroid hormone monitoring to determine long-term success of total parathyroidectomy for secondary hyperparathyroidism [J]. Head Neck, 2011, 33(3): 293-296.
[39]
Barczyński M, Cichoń S, Konturek A, et al. A randomised study on a new cost-effective algorithm of quick intraoperative intact parathyroid hormone assay in secondary hyperparathyroidism [J]. Langenbecks Arch Surg, 2005, 390(2): 121-127.
[40]
Lorenz K, Ukkat J, Sekulla C, et al. Total parathyroidectomy without autotransplantation for renal hyperparathyroidism: experience with a qPTH-controlled protocol [J]. World J Surg, 2006, 30(5): 743-751.
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