続発性上皮小体機能亢進症に対する上皮小体摘除術の治療成績についての検討

Abstract

1)内科的治療に抵抗する本症16例に対して, 上皮小体摘除術を施行, うち15例には上皮小体全摘除術および上皮小体組織自家移植術を行った.2)手術後の骨・関節痛, 皮膚そう痒感などの症状の改善は劇的であり, 単純X線写真上の骨変化や骨塩量も徐々に改善した.3) ALPは手術後徐々に低下した.PTHのうち, intact-PTHが手術後最も早期に低下した.4)移植腺再発は1例に認め, 移植腺摘除術を施行した

We performed parathyroidectomy for renal osteodystrophy due to secondary hyperparathyroidism on 16 patients with chronic renal failure who were refractory to medical management; subtotal parathyroidectomy on one patient and total parathyroidectomy with autotransplantation on 15 patients. Postoperative clinical improvement, i.e., bone and/or joint pain, pruritus and radiographic signs of renal osteodystrophy, was marked. After the operation, serum calcium decreased rapidly and adequate calcium replacement therapy was necessary. The levels of intact parathyroid hormone decreased rapidly and serum concentration of alkaline phosphatase gradually decreased for a few months postoperatively. Recurrence was diagnosed in one patient, who underwent excision of the transplanted parathyroid tissue. Osteomalasia due to hypoparathyroidism was not seen clinically in this series. In preoperative image diagnosis, ultrasonotomogram (US) showed the highest detective rate of the enlarged parathyroid glands. However, combination of US, computerized tomography and 99mTcO4(-)-201T1C1 scintigram can be recommended as a localizing diagnostic method for compensating the disadvantages of each method. Clinical results after parathyroidectomy for secondary hyperparathyroidism are considered to be good. However, long-term followup is mandatory for early detection of persistent hyperparathyroidism or hypoparathyroidism.