endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg12693endoserg-12693Research ArticleКлинические случаиCase reportsПерсистенция вторичного гиперпаратиреоза после ранее проведенной паратиреоидэктомии у пациентки с хронической болезнью почек: клинический случайPersistence of secondary hyperparathyroidism after parathyroidectomy in a patient with chronic kidney disease: a case reporthttps://orcid.org/0000-0002-2081-8665ИльичеваЕлена АлексеевнаIlyichevaElena A.

Доктор медицинских наук, профессор; SPIN:3624-4643

MD, PhD, Professor; SPIN:3624-4643

lena_isi@mail.ruhttps://orcid.org/0000-0002-6887-8325БерсеневГлеб АлександровичBersenevGleb A.

Аспирант; SPIN:1467-8503

SPIN:1467-8503

happy.endorphin@gmail.comhttps://orcid.org/0000-0002-2440-0813БулгатовДмитрий АлександровичBulgatovDmitry A.

Младший научный сотрудник, SPIN:1498-3741

SPIN:1498-3741

bbd-x@mail.ruhttps://orcid.org/0000-0001-7318-7193МахутовВалерий НиколаевичMakhutovValeriy N.

Кандидат медицинских наук, заведующий торакальным хирургическим отделением ГБУЗ ИОКБ; SPIN:7627-5484

MD, PhD; SPIN:7627-5484

iokb@iokb.ruФедеральное государственное бюджетное научное учреждение Иркутский научный центр хирургии и травматологииРоссияIrkutsk Scientific Centre of Surgery and TraumatologyRussian FederationГосударственное бюджетное учреждение здравоохранения Иркутская ордена Знак почета областная клиническая больницаРоссияIrkutsk Regional Clinical HospitalRussian Federation2020190620211431926Copyright © Ильичева Е.А., Берсенев Г.А., Булгатов Д.А., Махутов В.Н., 20212021Ильичева Е.А., Берсенев Г.А., Булгатов Д.А., Махутов В.Н.Ilyicheva E.A., Bersenev G.A., Bulgatov D.A., Makhutov V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/12693

Представлено клиническое наблюдение хирургического лечения персистенции вторичного гиперпаратиреоза (ВГПТ) у пациентки с хронической болезнью почек после ранее проведенной паратиреоидэктомии (ПТЭ). Программный гемодиализ начат в 2014 г., а в 2016 г. диагностирован ВГПТ. В ноябре 2018 г. в одной из клиник были выставлены показания к оперативному лечению. По данным сцинтиграфии наблюдалось повышение функциональной активности всех четырех околощитовидных желез (ОЩЖ), по данным УЗИ установлена локализация правой нижней, левой верхней и нижней ОЩЖ. Было проведено удаление 3 ОЩЖ без ревизии рогов тимуса (11.2018), при этом в послеоперационном периоде адекватного снижения паратгормона не наблюдалось. После дообследования по данным ультразвукового исследования, сцинтиграфии и мультиспиральной компьютерной томографии шеи с внутривенным усилением было установлено, что обе нижние ОЩЖ располагаются в верхних рогах тимуса. В июле 2020 г. выполнено повторное оперативное вмешательство в объеме правой нижней и левой нижней ПТЭ с положительной интраоперационной пробой. Ремиссия ВГПТ была достигнута. В настоящее время консенсуса в отношении объема оперативного вмешательства при ВГПТ не достигнуто, поскольку не обнаружено статистически значимых различий в частоте персистенции/рецидива ВГПТ. Необходима полная оценка результатов предоперационных методов визуализации при планировании оперативного вмешательства. Интраоперационный мониторинг ПТГ является эффективной методикой для оценки радикальности оперативного лечения.

This is a clinical case of surgical treatment of persistence of secondary hyperparathyroidism (SHPT) in a patient with chronic kidney disease after previous parathyroidectomy. Programmed hemodialysis started in 2014, and in 2016 SHPT was diagnosed. In November 2018, indications for surgical treatment were presented in one of the clinics. According to scintigraphy, an increase in the functional activity of all four parathyroid glands (PTG) was observed, according to ultrasound data, the localization of the right lower, left upper and lower PTG was established. Removal of 3x PTG was performed without revision of the thymus horns (11.2018), while in the postoperative period, an adequate decrease in parathyroid hormone was not observed. After additional examination, according to ultrasound, scintigraphy and computer tomography of the neck with intravenous enhancement, it was found that both lower PTGs are located in the upper horns of the thymus. In July 2020, a repeated surgical intervention was performed in the volume of the right lower and left lower parathyroidectomy with a positive intraoperative test. Remission of SHPT was achieved. At present, no consensus has been reached on the extent of surgery for SHPT, since no statistically significant differences were found in the incidence of persistence / recurrence of SHPT. A complete assessment of the results of preoperative imaging techniques is required when planning surgery. Intraoperative monitoring of parathyroid hormone is an effective technique for assessing the radicality of surgical treatment.

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The authors declare that there are no conflicts of interest present.