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말기 신부전 환자에서 부갑상선 기능항진증으로 외과적 부갑상선 절제술을 시행 받은 환자의 임상적 경과

Title
 말기 신부전 환자에서 부갑상선 기능항진증으로 외과적 부갑상선 절제술을 시행 받은 환자의 임상적 경과
Other Titles
 Clinical Characteristics of ESRD Patients with Severe Hyperparathyroidism Who Undertook Surgical Parathyroidectomy
Authors
 한승혁; 이상철; 박정수; 정웅윤; 서진학; 한대석; 이호영; 최규헌; 강신욱; 최소래; 윤도식; 윤수영; 노현진; 노현정; 박형천; 구영석; 강이화
Issue Date
2002
Journal Title
 Korean Journal of Nephrology (대한신장학회지)
ISSN
 1225-0015
Citation
 Korean Journal of Nephrology (대한신장학회지), Vol.21(1) : 108~116, 2002
Abstract
Background : Medical treatments such as restriction of phosphate, phosphate binder use, and active vitamine D therapy have been widely used for hyperparathyroidism in ESRD patients, and surgical parathyroidectomy should be considered in patients with uncontrolled hyperparathyroidism. Methods : A retrospective study was performed in 24 ESRD patients with severe and uncontrolled hyperparathyroidism despite of medical treatment who undertook surgical parathyroidectomy in Severance hospital from 1990 to 1999. Results : Sixteen patients had total parathyroidectomy with immediate autotransplant, 7 patients had subtotal parathyroidectomy and only 1 patient had minimally invasive parathyroidectomy. An excellent short-term control of hyperparathyroidism was achieved in all patients after parathyroidectomy. PreResults : Sixteen patients had total parathyroidectomy with immediate autotransplant, 7 patients had subtotal parathyroidectomy and only 1 patient had minimally invasive parathyroidectomy. An excellent short-term control of hyperparathyroidism was achieved in all patients after parathyroidectomy. Preoperative bone and joint pain improved in 16 of 19 patients. Muscle weakness and pain improved in 11 of 17 patiens, malaise improved in 8 of 10 patients and pruritus improved in 10 of 13 patients. In addition, clinical laboratory finding improved after parathyroidectomy. No clinical differences were seen between 16 patients who undertook total parathyroidectomy with immediate autotransplant and 7 patients who undertook subtotal parathyroidectomy. Recurrence of hyperparathyroidism ocurred in 5 of 24 patients with 4 nodular hyperplasia and 1 diffuse hyperplasia in pathologic finding. The less degree of attenuated response of intact PTH levels immediately after operation was observed in 5 recurrent cases. Conclusion : Good results were obtained after parathyroidectomy. We believe that histologic subtype and the attenuated response of intact PTH after surgical parathyroidectomy could be possible predictors of the recurrent hyperparathyroidism.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/142539
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
Yonsei Authors
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