二次性上皮小体機能亢進症に対する上皮小体全摘除術ならびに自家移植術後の長期成績

Abstract

1)上皮小体全摘除術ならびに自家移植術施行1年以上の長期予後を術後平均31.7ヵ月(12～70ヵ月)の19名で自覚的変化, 生化学的指標の推移, 骨塩量変動について検討を行った.最終観察時骨関節痛を認めたのは19例中5例であった. 2)長期術後の再発, 持続上皮小体機能亢進症と考えられた症例は15.8%, 骨軟化症と考えられた症例が10.5%の頻度で疑われた. 3)骨塩量の低下を認めたのは女性のみであった為, 閉経後の骨粗鬆症の関与も考慮すべきと考えられた

Although the short-term outcome of total parathyroidectomy combined with autotransplantation in cases of renal osteodystrophy has been reported by many investigators, few studies have been made on the long-term outcome of this surgical technique. We recently examined the long-term outcome of this surgery by following 19 cases for more than one year (range: 12-70 months, mean: 31.7 months). During the follow-up period, changes in subjective symptoms, biochemical parameters and bone mineral density (BMD) were monitored. At the end of the follow-up period, C-parathyroid hormone (C-PTH) and alkaliphosphatase (ALP) were significantly lower than their preoperative levels. Ca, P and %BMD showed no significant change from their preoperative levels, although %BMD tended to be higher than its preoperative level. Depending on the presence or absence of osteoarticular pain at the end of the follow-up period, the patients were divided into the improved group and the non-improved group. Of the 5 patients allocated to the non-improved group, 4 were female and only 1 was male. C-PTH and ALP were significantly higher in the non-improved group. %BMD was higher in the improved group than in the non-improved group, although this difference was not significant. In the non-improved group, 2 patients were suspected of having extra parathyroids, 1 was suspected of having recurrence, and 2 were suspected of having postoperative osteomalacia. Postoperative reduction in BMD was only seen in females, suggesting its relationship to postmenopausal osteoporosis.