[Personal experience with surgical treatment of hyperparathyroidism in chronic kidney failure. II. Surgical technic, postoperative course and the state of bone metabolism after parathyroidectomy].
In 20 haemodialyzed patients operated on account of HPT, in 12 instances total PTE was performed with autotransplantation of portions of the parathyroid gland and in 8 patients so-called partial PTE was performed, leaving one parathyroid gland (in one instance two). Histomorphological examination revealed diffuse to nodular hyperplasia and twice an adenoma of the parathyroid; the mean weight of the excised tissue was 4000 mg. The follow-up period after operation varied from two months to 36 months. After total PTE the regression of HPT is more marked and more rapid. Possible relapses are more probable after partial PTE, also the possible development of hyperplasia of the implanted tissue cannot be ruled out. A new rise of C-HPT levels precedes changes of the clinical picture and a rise of indicators of bone metabolism. From linear correlations between serum levels of the ALP bone fraction, total ACP, free OH-P and values of C-PTH (p less than 0.01-0.001) conclusions can be drawn on regression or progress of the osseous finding after PTE. Data on the possible participation of aluminum osteopathy are essential, as in the florid stage it is a contraindication of PTE. The positive effect of operation recorded in 17 patients comprised not only restoration of a satisfactory mobility but also an improved mental condition. Surgical treatment of advanced forms of HPT in dialyzed patients is therefore still considered an indicated operation, provided these patients receive subsequently further aimed care.
Kocandrle
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V
Sotorník
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I
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008722:Methods; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery*; D011183:Postoperative Complications
Nase zkusenosti s chirurgickým lécením hyperparatyreoidismu pri chronickém selhání ledvin. II. Technika operacního výkonu, pooperacní průbĕh a stav kostního metabolismu po paratyreoidektomii.