Study on the complete parathyroidectomy and parathyroid autoimplantation for secondary parathyroidism in chronic renal failure

: We studied on the operative indication and therapeutic effect of complete parathyroidectomy and autoimplantation for chronic hemodialysis. Twenty three surgical resections were performed on 21 patients who had been received long-term hemodialysis. Total resected glands from these patients were 83 and the mean total parathyroid's weight was 3.2 gram. The detection rate of hyperparathyroidism was 50.0% by scintigram, and 72.9% by computed tomography (CT). The mean diameter of resected glands proved to be 5 to 6mm larger than that estimated by CT. There was no statistical correlation between the durations of hemodialysis and the total parathyroid's weights. Our study revealed that the mean weight of 5 cases without 1,25(OH)2D3-plus therapy was 5.8 gram, which was significantly heavier than that with this therapy. Histopathologically, the larger glands often showed nodular growth, but the smaller glands tended to show diffuse hyperplasia. There was a positive correlation (r = 0.93, p < 0.01) between the weights of the resected glands and serum CPTH values only in those cases with the glands weighing equal or less than 4 gram.