Son dönem böbrek yetmezliği nedeniyle tedavi gören ve son 10 yılda hastanemizde paratiroidektomi yapılan hastaların sonuçlarının retrospektif olarak değerlendirilmesi
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Tarih
2024
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Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Sekonder hiperparatiroidi, kronik böbrek yetmezliği tanılı hastalarda gelişen, morbidite ve mortalitenin artışına neden olan bir durumdur. Kronik böbrek yetmezliğine bağlı mineral ve kemik bozuklukları kapsamında değerlendirilir. Çalışmamızda sekonder hiperparairoidi nedeniyle Necmettin Erbakan Üniversitesi Tıp Fakültesi hastanesinde opere olan hastaların, demografik özellikleri, laboratuvar, görüntüleme ve patoloji sonuçları, operasyon tipleri ve erken-geç dönem komplikasyonları değerlendirilerek hastaların operasyon başarılarına etki eden faktörlerin araştırılması amaçlanmıştır.
Yöntem: Ocak 2013 ve Ocak 2023 arasında hastanemizde sekonder hiperparatiroidi nedeniyle paratiroidektomi olan son dönem böbrek yetmezliği tanılı hastaların parathormon ve rutin laboratuvar tetkikleri elde edilmiştir. Boyun ultrasonografisi, paratiroid sintigrafisi, bilgisayarlı tomografi ve manyetik rezonans ile gerçekleştirilen görüntülemelerin sonuçları toplanmıştır. Hastaların ameliyat raporları ve patoloji raporları incelenmiştir. Elde edilen bulgular SPSS 18.0 paket progamı kullanılarak analiz edilmiştir.
Bulgular: Bu süreçte toplamda 78 hasta sekonder hiperparatiroidi nedeniyle paratiroidektomi operasyonu geçirmiştir. Bu hastaların 11 adedi veri yetersizliği nedeniyle çalışma dışı bırakılarak 67 hasta üzerinden analizler gerçekleştirilmiştir. 45 hastada (%67,1) ultrasonografi ve sintigrafi kombine kullanılarak görüntüleme yapılmıştır. 20 hastada (%29,8) adenom saptanırken 47 hastada (%70,1) hiperplazi saptanmıştır. Toplamda 43 hastada postoperatif hipokalsemi izlenmiştir ve bu hastalardan 24’ünde ilerleyen dönemde kalıcı hipokalsemi görülmüştür. 7 hasta ikinci defa operasyon geçirmiş olup bu hastaların 6’sı persistan hiperparatiroidi nedeniyle opere olurken 1 hastada nüks izlenmiştir.
Sonuç: Son 10 yılda kullanımı yaygınlaşan kalsimimetik tedavilerle birlikte paratiroidektomi ihtiyacı ertelenebilse de medikal tedaviye dirençli vakalarda paratiroidektomi, sekonder hiperparatiroidi tedavisi açısından hala geçerli bir seçenektir. Hastaların kombine görüntüleme yöntemleri ile tetkik edilmesi görüntüleme başarısını arttırmaktadır. Erken dönemde hipokalsemi bu hastalarda operasyon sonrasında izlenen önemli bir komplikasyondur. En sık izlenen uzun dönem komplikasyon ise kalıcı hipoparatiroidi olup bu açıdan hastalar erken ve geç dönemde yakın izlenmelidirler.
Objective: Secondary hyperparathyroidism is a condition that develops in patients with chronic kidney disease, leading to increased morbidity and mortality. It is considered within the scope of mineral and bone disorders associated with chronic kidney disease. In our study, the aim was to investigate factors affecting the surgical success of patients undergoing surgery at Necmettin Erbakan University Faculty of Medicine Hospital due to secondary hyperparathyroidism by evaluating the demographic characteristics, laboratory, imaging, and pathology results, types of operations, and early-late complications. Method: Parathyroidectomy was performed on patients with end-stage renal failure due to secondary hyperparathyroidism in our hospital between January 2013 and January 2023. Parathormone and routine laboratory tests of these patients were obtained. The results of imaging studies performed with neck ultrasound, parathyroid scintigraphy, computed tomography, and magnetic resonance imaging were collected. The patients' surgical and pathology reports were reviewed. The obtained data were analyzed using the SPSS 18.0 package program. Results: During this period, a total of 78 patients underwent parathyroidectomy due to secondary hyperparathyroidism. Eleven of these patients were excluded from the study due to insufficient data, and analyses were performed on 67 patients. Imaging was performed using a combination of ultrasound and scintigraphy in 45 patients (67.1%). Adenoma was detected in 20 patients (29.8%), while hyperplasia was found in 47 patients (70.1%). Postoperative hypocalcemia was observed in 43 patients, and 24 of them experienced persistent hypocalcemia in the later period. Seven patients underwent a second operation, with six of them undergoing surgery due to persistent hyperparathyroidism, and one patient experienced recurrence. Conclusion: Despite the increasing use of calcimimetic therapies in the last decade, parathyroidectomy remains a valid option for the treatment of secondary hyperparathyroidism in cases resistant to treatment. The use of combined imaging methods improves imaging success. Early hypocalcemia is a significant complication observed in these patients after surgery. The most commonly observed long-term complication is permanent hypoparathyroidism, and patients should be closely monitored in both the early and late periods in this regard.
Objective: Secondary hyperparathyroidism is a condition that develops in patients with chronic kidney disease, leading to increased morbidity and mortality. It is considered within the scope of mineral and bone disorders associated with chronic kidney disease. In our study, the aim was to investigate factors affecting the surgical success of patients undergoing surgery at Necmettin Erbakan University Faculty of Medicine Hospital due to secondary hyperparathyroidism by evaluating the demographic characteristics, laboratory, imaging, and pathology results, types of operations, and early-late complications. Method: Parathyroidectomy was performed on patients with end-stage renal failure due to secondary hyperparathyroidism in our hospital between January 2013 and January 2023. Parathormone and routine laboratory tests of these patients were obtained. The results of imaging studies performed with neck ultrasound, parathyroid scintigraphy, computed tomography, and magnetic resonance imaging were collected. The patients' surgical and pathology reports were reviewed. The obtained data were analyzed using the SPSS 18.0 package program. Results: During this period, a total of 78 patients underwent parathyroidectomy due to secondary hyperparathyroidism. Eleven of these patients were excluded from the study due to insufficient data, and analyses were performed on 67 patients. Imaging was performed using a combination of ultrasound and scintigraphy in 45 patients (67.1%). Adenoma was detected in 20 patients (29.8%), while hyperplasia was found in 47 patients (70.1%). Postoperative hypocalcemia was observed in 43 patients, and 24 of them experienced persistent hypocalcemia in the later period. Seven patients underwent a second operation, with six of them undergoing surgery due to persistent hyperparathyroidism, and one patient experienced recurrence. Conclusion: Despite the increasing use of calcimimetic therapies in the last decade, parathyroidectomy remains a valid option for the treatment of secondary hyperparathyroidism in cases resistant to treatment. The use of combined imaging methods improves imaging success. Early hypocalcemia is a significant complication observed in these patients after surgery. The most commonly observed long-term complication is permanent hypoparathyroidism, and patients should be closely monitored in both the early and late periods in this regard.
Açıklama
Anahtar Kelimeler
Kronik Böbrek Yetmezliği, Hiperparatiroidi, Paratiroidektomi, Chronic Kidney Failure, Hyperparathyroidism, Parathyroidectomy
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WoS Q Değeri
Scopus Q Değeri
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Künye
Kanat, B. K. (2023). Son dönem böbrek yetmezliği nedeniyle tedavi gören ve son 10 yılda hastanemizde paratiroidektomi yapılan hastaların sonuçlarının retrospektif olarak değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
