为了制定基于证据的安全建议,有效,并适当治疗继发性(SHPT)和第三性(THPT)肾脏甲状旁腺功能亢进。
甲状旁腺功能亢进在慢性肾脏病患者中很常见,终末期肾病,和肾脏移植。SHPT和THPT的手术管理是微妙的,需要多学科的方法。目前尚无针对SHPT和THPT的手术治疗的临床实践指南。
从1985年1月1日至2021年1月1日,由SHPT和THPT的10名专家组成的小组审查了医学文献。构建了使用最佳可用证据的建议。美国医师学会评分系统用于确定证据水平。对建议进行了协商一致的讨论。美国内分泌外科医师协会成员对内容的初稿进行了审查和评论。
这些临床指南介绍了SHPT和THPT的流行病学和病理生理学,并为所有相关临床医生提供了SHPT和THPT的工作和管理建议。它概述了术前,术中,以及SHPT和THPT的术后管理,以及相关的定义,手术技术,发病率,和结果。具体主题包括发病机制和流行病学,初步评估,成像,术前和围手术期护理,手术计划和甲状旁腺切除术,附件和方法,结果,和再操作。
制定了循证指南,以帮助临床医生优化二级和三级肾甲状旁腺功能亢进的治疗。
To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism.
Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice
guidelines that address the surgical treatment of SHPT and THPT.
Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to
consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content.
These clinical
guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and
Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation.
Evidence-based
guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.