Acta biomedica scientifica Acta biomedica scientifica Acta biomedica scientifica 2541-9420 2587-9596 14152 10.12737/22938 Клиническая медицина Clinical Medicine Клиническая медицина EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ВТОРИЧНОГО ГИПЕРПАРАТИРЕОЗА Рожанская Елена Вячеславовна Rozhanskaya Elena Вячеславовна Махутов Валерий Николаевич Makhutov Valeriy Nikolaevich iokb@iokb.ru

кандидат медицинских наук;

candidate of medical sciences;

 Булгатов Дмитрий Александрович Bulgatov Dmitriy Aleksandrovich bbd-x@mail.ru Жаркая Анастасия Валерьевна Zharkaya Anastasiya Valeryevna ava_irk@inbox.ru Ильичёва Елена Алексеевна Ilicheva Elena Алексеевна lena_isi@mail.ru Папешина Светлана Андреевна Papeshina Svetlana Андреевна Иркутской ордена «Знак Почета» областной клинической больницы Иркутск Россия Irkutsk Regional Clinical Hospital Irkutsk Russian Federation Иркутский научный центр хирургии и травматологии Россия Иркутский научный центр хирургии и травматологии Russian Federation 30 11 2016 30 11 2016 1 4 29 35 https://zh-szf.ru/en/nauka/article/14152/view

Представлен анализ результатов хирургического лечения уремического гиперпаратиреоза у 34 пациентов. Было выполнено 36 оперативных вмешательств, из них 34 первичных (16 субтотальных паратиреоидэктомий (СПТЭ), 13 тотальных паратиреоидэктомий (ТПТЭI), 5 тотальных паратиреоидэктомий с удалением центральной клетчатки шеи, верхнего средостения и верхних рогов тимуса (ТПТЭII)) и 2 повторных (ТПТЭ II и паратиреоидаденомэктомия). Показано снижение частоты персистенции заболевания с источником, доступным из шейного разреза при выполнении ТПТЭII.

Surgical treatment of secondary hyperparathyroidism (HPT) in patients having renal replacement therapy (RRT) is a current problem. The aim of our study was to optimize the treatment of secondary HPT based on the comparative analysis of effectiveness of the surgeries with different extents. We conducted a retrospective analysis of the results of surgical treatment of uremic HPT in 34 patients. 36 surgeries were performed including 34primary (16subtotal parathyroidecomies (PTE), 13total parathyroidecomies (total PTEI), 5total parathyroidecomies with central neck dissection and resection of superior mediastinum and superior thymus horns (total PTEII)) and 2repeated surgeries (total PTEII and parathyroidadenomectomy). Gross examination of 134 surgical specimens revealed dyssynchronous pathological changes in parathyroid glands (PTG), normal PTG structure was found in 2cases. Recurrent HPT was found in 3 cases, persistent HPT – in 9cases, hypoparathyroidism – in 5cases after subtotal PTE and in 9 cases after total PTE with autotransplantation (p=0,267). Target values of parathyroid hormone were registered in 8patients, including 4 patients after subtotal PTE and 4 patients after total PTE (p>0,95). Morbidity was similar in all types of surgeries (p>0,5). Analysis of morbidity determined that simultaneous surgery of thyroid gland increased the risk of laryngeal paralysis (р=0,028). The decrease in occurrence of secondary HPT persistence (with the source accessible for removal through cervical approach) at total PTE based on the removal of parathyroid glands of all localizations accessible through cervical approach (including thyroid gland lobes with diagnosed ectopia, central cervical fat pad, superior mediastinum and superior thymus horns) was registered (NNT=4).

 вторичный гиперпаратиреоз паратиреоидэктомия secondary hyperparathyroidism parathyroidectomy

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