在副甲状腺切除过程中,在患有末期脏病的患者中,对于二次性副甲状腺功能障碍的甲状腺切除是必要的吗?
Joy Z Done1, Andrew Gabrielson2, Rachel Stemme2
1Division of Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: https://twitter.com/JoyZhouDone.
Surgery
|October 10, 2024
概括
二次性甲状腺功能障碍症的副甲状腺切除术期间的甲状腺切除术是罕见的,并且正在下降. 这项研究发现,与甲状腺切除术或没有甲状腺切除术的患者之间的复发率没有显著差异.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 准则建议在副甲状腺切除期间进行甲状腺切除术,以预防二次性副甲状腺功能障碍,以防止持续性或复发性疾病.
- 在这种情况下,甲状腺切除术的实际频率和影响尚未得到充分确立.
研究的目的:
- 为了确定同时进行甲状腺切除术和副甲状腺切除术的频率,用于二次性副甲状腺功能障碍.
- 调查甲状腺切除术对二次性甲状腺功能障碍症复发的影响.
主要方法:
- 一个回顾性队列研究,使用TrinetX多机构EHR和索赔网络 (2005-2023).
- 甲状腺切除术,重复甲状腺切除术和二次性甲状腺功能障碍症的成年人中使用甲状腺切除术和甲状腺切除术或没有甲状腺切除术的甲状腺切除术的比较率.
- 通过副甲状腺激素水平,重新手术或仿药的使用来定义复发.
主要成果:
- 在2564名患者中,有2272名 (88.8%) 患有甲状腺切除术,287名 (11.2%) 患有甲状腺切除术+甲状腺切除术.
- 联合手续率从2005年的25.5%下降到2023年的10.1%.
- 在手术后的副甲状腺激素水平,模仿剂的使用,再手术率或移植之间没有观察到显著差异.
结论:
- 对于二次性甲状腺功能障碍症的副甲状腺切除术期间的胸膜切除术很少进行,其利用率正在下降.
- 目前的证据表明,乳腺切除术并不能显著降低二次性副甲状腺功能障碍的复发率.
- 未来的研究应该考虑甲状腺切除术的程度,以澄清甲状腺切除术在复发管理中的作用.
相关概念视频
01:26Kidney Transplant II: Surgical Procedure
2
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
2
01:28Kidney Transplant I: Introduction
2
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
2
00:59The Parathyroid Glands
1.9K
The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
1.9K
01:16Kidney Transplant III: Nursing Management
3
Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
3
01:28Chronic Kidney Disease III: Interprofessional Care
2
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
2
01:17Hormones and Bone Tissue
2.6K
The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
Hormones That Influence Osteoblasts and/or Maintain the Matrix
Several hormones are necessary for controlling bone growth and maintaining the bone matrix. The pituitary gland secretes growth hormone (GH), which, as its name implies, controls bone growth. This happens in several ways: first, it triggers chondrocyte...
Hormones That Influence Osteoblasts and/or Maintain the Matrix
Several hormones are necessary for controlling bone growth and maintaining the bone matrix. The pituitary gland secretes growth hormone (GH), which, as its name implies, controls bone growth. This happens in several ways: first, it triggers chondrocyte...
2.6K