Évaluation des parathyroïdectomies chez l'insuffisant rénal chronique dialysé

Abstract : Aim. Evaluation of three parathyroidectomies (subtotal, selective, partial) in refractory renal hyperparathyroidism by comparing short and long term follow-up parathormone (PTH) assay. Methods. Patients with uncontroled renal hyperparathyroidism despite medical treatment, followed in the nephrology unit of Caen University Hospital, who underwent a cervical exploration of the fourth parathyroid sites, between 2000 and 2017, were retrospectively included. They were divided into three groups correlated to their surgical procedures. The primary safety endpoint was one-year follow-up PTH assays for each operative techniques. Results. 47 patients divided in 3 groups: PTX 7/8 (n=22), PTX ¾ (n=13) and PTXp (n=12) presented a significative lower PTH rate at a-year follow up, whatever PTX (p=0,024). No differences were found with calcium and phosphorus rates. After a mean follow-up of 37 months, no significative differences were found in recurrence-free survival towards operative procedure (p=0,270). Overall recurrence rate was 28%. Complications noticed were a vocal fold palsy, a cervical hematoma, and 18% of hypoparathyroidism related 6 month postoperatively for group PTX 7/8e. Conclusion. Refractory secondary hyperparathyroidism clearly needs a four-parathyroid sites exploration. PTX 7/8e show efficacity in recurrence-free survival and post operative PTH assays, with necessary improved calcium homeostasis. Selective PTX ¾ seems to show outcomes to keep enought functional parathyroid tissus for a better post operative phosphocalcic balance.
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Master Thesis
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Édouard Bouquillon. Évaluation des parathyroïdectomies chez l'insuffisant rénal chronique dialysé. Médecine humaine et pathologie. 2018. ⟨dumas-02052608⟩



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