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題 名 | Clinical Course after Parathyroidectomy in Uremic Patients of a Center in Southern Taiwan=南臺灣一所醫學中心透析病人在接受副甲狀腺切除術後之臨床病程探討 |
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作 者 | 甘偉志; 簡志強; 王憲奕; 王嬋婷; 黃志強; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷 期 | 23:3 2009.09[民98.09] |
頁 次 | 頁155-163+187 |
分類號 | 415.816 |
關鍵詞 | 副甲狀腺切除術; 續發性甲狀腺機能亢進症; 透析; Parathyroidectomy; Secondary hyperparathyroidism; Dialysis; |
語 文 | 英文(English) |
英文摘要 | Background: Surgical parathyroidectomy (PTX) is indicated for end-stage renal disease (ESRD) patients with secondary hyperparathyroidism unresponsive to conventional therapies. We conducted a retrospective study to evaluate the changes in intact parathyroid hormone (iPTH) levels and the postoperative responses of mineral biochemical parameters. Methods: We recruited 36 dialysis patients who underwent total PTX with autotransplantation from January 2002 to December 2007. Laboratory data including serum iPTH, corrected total calcium (cCa), phosphate (PO4), corrected total calcium-phosphate product (cCa x PO4) and total alkaline phosphatase (tAP) were collected pre-operation and at follow-up monthly post-operation. Results: Besides two (5.9%) patients who showed persistent postoperative hyperparathyroidism, the other 34 patients had a significant decrease in postoperative serum iPTH, cCa, PO4 and cCa x PO4. Conversely, there was a transient postoperative rise in tAP in the first month after surgery (p<0.05). Among the 34 patients with successful outcome, 8 patients (23%) presented with hungry bone syndrome. This raise in tAP levels showed a trend of positive correlation with the decrease in cCa x PO4 (r=0.32, p=0.06). During the 3-year followup, significant reductions in serum iPTH, cCa, PO4, cCa x PO4 and tAP levels as compared with preoperative levels (p<0.05) were found. Conclusions: We concluded that PTX led to a significant improvement in iPTH, cCa, PO4 and cCax PO4 levels after surgery, and most patients maintained lower iPTH levels throughout the 3-year follow-up. |
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