부갑상선 질환 및 치료 방침

• 영문명: Disease of Parathyroid and Surgical Strategy
• 발행기관: 대한내분비외과학회
• 저자명: 이재복 Jae Bok Lee
• 간행물 정보: 『The Koreran journal of Endocrine Surgery』12권4호, 225~230쪽, 전체 6쪽
• 주제분류: 의약학 > 일반외과학
• 파일형태: PDF
• 발행일자: 2012.12.30

영문 초록

The role of surgery in parathyroid disease has shown a recent decrease with development of calcinomimetics such as cinacalcet. During thyroid surgery, every endocrine surgeon makes every effort to preserve the parathyroid gland. However, postoperative hypoparathyroidism cannot be completely prevented. Knowledge of the precise anatomy of the parathyroid, including embryological movement of parathyroid glands, is needed. Surgical indications of parathyroidectomy include primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism and parathyroid carcinoma. Parathyroidectomy for primary hyperparathyroidism has shown a significant change due to introduction of the sestamibi scan, intraoperative PTH assay, and focused parathyroidectomy. Minimally invasive surgery has now become standard operation for primary hyperparathyroidism. However, focused unilateral parathyroid operation should be done very cautiously because you can lose the chance of cure. Recurrence rate after parathyroidectomy is approximately 5% and experience of a surgeon can only reduce this rate. Surgery for secondary hyperparathyroidismis performed in only 1∼2% of CKD patients. Surgical methods include subtotal parathyroidectomy, total parathyroidectomy, and total parathyroidectomy with autotransplantation and the results of the operation are not different. With the introduction of cinacalcet, comparison between surgery and medication showed an effective drop down of serum PTH level and increase of BMD only in surgery. Cincalcet did not show improvement of mortality, vascular calcification, and nephrplithiasis. According to oneJapanese report, PTH more than 500 pg/ml, size larger than 1 cm, and more than two enlarged parathyroid favor parathyroidectomy in renal osteodystrophy. During parathyroid surgery, high suspicion for carcinoma gives the only chance for cure because en bloc resection is important. Parathyroid disease has evolved since introduction of Cinacalcet and endocrine surgeons should join with physicians as a team for development of a treatment plan.

키워드

부갑상선, 부갑상선기능항진증, 부갑상선암, 부갑상선절제술,Parathyroid, Hyperparathyroidism, Parathyroid carcinoma, Parathyroidectomy