继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT），是指钙离子动态平衡紊乱导致代偿性甲状旁腺素（PTH）的过度分泌。大多数SHPT的病人主要依赖药物治疗。需行甲状旁腺切除术（parathyroidectomy，PTx）治疗的SHPT主要为慢性进展性肾脏疾病或长期需要锂治疗的病人。目前，仍不能肯定哪种手术方式对于进展性SHPT最为有效。一般选择手术方式时需重点考虑病人的因素包括病人是否需要进行肾脏移植、病人的年龄、PTx后预期的存活率和病人获得并遵守药物治疗的能力。我们认为全甲状旁腺切除+前臂自体移植更适合于PTx术后需要长期透析的病人，因为当出现再次复发时，与颈部探查相比，将残余的甲状旁腺组织由前臂移除的手术过程安全且操作简单。

Surgical treatment of secondary hyperparathyroidism               DAI Wen-jie, XU De-quan. Department of Thyroid-breast-cell-transplantation Surgery, the First  Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: DAI Wen-jie, E-mail: davidhmu@163.com
Abstract    Secondary hyperparathyroidism (SHPT) refers to a derangement in calcium homeostasis leading to a compensatory increase in parathyroid hormone (PTH) secretion. Most SHPT patients depend on medication. SHPT requiring parathyroidectomy (PTx) occurs more commonly in progressive chronic kidney disease (CKD) and in long-term lithium therapy. At present, after thoughtful review which procedure is the most suitable operative procedure for patients with advanced SHPT still can’t be determined. The decision may depend on the surgeon's preference and the clinical status of the patients. Important patient issues in choosing a specific procedure is whether the patient is a candidate for kidney transplantation, patient age, expected survival after PTx, and the patient's ability to obtain and comply with medication. For patients who require long-term hemodialysis after PTx, the risk for recurrence is not negligible, as it is easier and safer to remove residual parathyroid tissue from the forearm at recurrence as compared with a neck reexploration. Thus, total PTx with forearm autograft is the preferred option in a patient who has to continue hemodialysis for long periods after PTx.