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Year 2014 Vol. 22 No 5

TRANSPLANTOLOGY

A.M. PISARENKO1,2, Y.E. DEMIDCHIK1, O.V. ILYINCHYK1,3, V.Y.KHRYSHCHANOVICH4, A.N. KOZLOVSKAYA2,4, D.G. BALASHOVA4, O.I. KENDENKOV4

SURGICAL TREATMENT RESULTS OF SECONDARY HYPERPARATHYROIDISM WITH PARATHYROID AUTOTRANSPLANTATION APPLICATION

SEE “Belarusian Medical Academy of Post-graduate Education” 1,
ME “Minsk City Clinical Ontological Dispensary” 2,
ME “The 1st City Clinical Hospital”3, Minsk,
EE “Belarusian State Medical University”4, Minsk,
The Republic of Belarus

Objectives. To study the effectiveness of surgical treatment of the secondary hyperparathyroidism with parathyroid autotransplantation application.
Methods. A retrospective data analysis of 39 patients receiving the renal replacement therapy in hemodialysis department of ME “The 1st Clinical Hospital” and suffering from the secondary hyperparathyroidism; they were subjected to parathyroidectomy (PTE) with autotransplantation of the parathyroid tissue on the basis of the head and neck tumors department of ME “Minsk City Clinical Oncologic Dispensary”. Patients’ average age was 50 [44-55] years. Parathyroid autograft was stored in sterile cold NaCl solution, grinded and implanted into brachioradialis muscle of the forearm. Serum levels of calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase have been evaluated in the postoperative period.
Results. Postoperative follow-up period made up 21 [12-24] months. Transient hypocalcaemia has developed in 5 patients. The recurrence of hyperparathyroidism was observed in two cases and reoperation was carried out. During follow-up period we observed the stable and statistically significant (P≤0,01) reduction of serum PTH, calcium and phosphate in comparison with initial levels, wherein differences in the level of PTH in 1 month and 24 months after PTE was unreliable (p<0,8). Sensitivity of US and scintigraphy of the parathyroid glands with Tc-99m-MIB I in regard to the nature of parathyroid pathology was 79.9%.
Conclusion. Total PTE with autologous parathyroid tissue transplantation in the forearm muscles is considered to be a highly effective and pathogenetic reasonable method of treatment of severe secondary renal hyperparathyroidism in dialysis patients. Along with safety, a small number of complications and the lack of lethality, the developed technology allowed reducing the recurrence rate of hyperparathyroidism, preventing the development of postoperative hypoparathyroidism, achieving a good cosmetic effect, shortening the time of hospitalization.

Keywords: chronic renal insufficiency, secondary hyperparathyroidism, surgical treatment, autotransplantation
p. 582-588 of the original issue
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Address for correspondence:
220116 Respublika Belarus,
g. Minsk, prospekt Dzerzhinskogo, d. 83,
UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet»,
2-ya kafedra hirurgicheskih bolezney,
tel. office: 375 17 287-86-52,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Yanovich
Information about the authors:
Pisarenko A.M. Head of the head and neck tumors unit of ME “Minsk City Clinical Oncologic Dispensary”.
Demidchik Y.E. MD, professor, corresponding member of NAS RB, Rector of SEE “Belarusian Medical Academy of Post-graduate Training”.
Ilyinchyk O.V. A nephrologists, head of the hemodialysis department with the unit of peritoneal dialysis of ME “The 1st City Clinical Hospital”.
Khryshchanovich V.Y. PhD, associate professor of the 2nd surgical diseases chair of EE “Belarusian State Medical University”.
Kozlovskaya A.N. PhD, an assistant of the oncology chair of EE “Belarusian State Medical University”.
Kendenkov O.I. A 6-year student of EE “Belarusian State Medical University”.
Balashova D.G. A 6-year student of EE “Belarusian State Medical University”.
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