中国普外基础与临床杂志

中国普外基础与临床杂志

50 例尿毒症继发性甲状旁腺功能亢进患者的手术疗效分析

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目的 探讨不同的甲状旁腺切除术(PTX)治疗尿毒症继发性甲状旁腺功能亢进(SHPT)的疗效。 方法 收集 2016 年 1 月至 2018 年 3 月期间在武汉大学人民医院接受 PTX 的 50 例 SHPT 患者的临床资料,比较患者术前及术后 1 和 7 d 及 1、3、12 个月时的血清全段甲状旁腺激素(iPTH)、血钙及血磷的变化,并观察治疗后临床症状变化、术后并发症及复发情况。 结果 50 例患者中行甲状旁腺次全切除术(SPTX)10 例、甲状旁腺全切除术(TPTX)5 例及 TPTX+自体移植术(TPTX+AT)35 例。47 例(94.0%)患者手术成功,3 例患者未成功,其中 SPTX、TPTX 及 TPTX+AT 中各有 1 例手术未成功(χ2=3.351,P=0.211)。术后患者骨痛、瘙痒等症状均缓解。有 3 例发生一过性喉返神经损伤,1 例发生甲状旁腺功能减退,38 例术后发生低钙血症。患者术后不同时相的 iPTH、血钙及血磷水平较术前明显降低(P<0.050)。术后 3 个月及 12 个月时的复发率分别为 10.0%(5/50)及 9.1%(2/22),术后 3 个月时 SPTX、TPTX+AT、TPTX 分别有 1 例、3 例及 1 例复发(χ2=1.321,P=0.753),术后 12 个月时 SPTX、TPTX+AT 及 TPTX 分别有 1 例、1 例及 0 例复发(χ2=1.794,P=0.411)。 结论 目前国内治疗尿毒症 SHPT 最常用的术式为 TPTX+AT,SPTX 和 TPTX 同样安全、有效,也可改善患者各项指标,提高生存质量,可根据患者具体情况个体化选择。

Objective To explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease. Methods The clinical data of 50 patients who underwent PTX for uremic SHPT from January 2016 to March 2018 were collected retrospectively. The changes of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) before the surgery, and 1 d, 7 d, 1 month, 3 months and 12 months after the surgery were analyzed. In addition, the improvement of clinical symptoms together with the postoperative recurrence rate and the complications data (e.g., hypocalcemia, hypoparathyroidism) were observed to determine the efficacy of PTX. Results Ten patients underwent the subtotal PTX (SPTX), 5 cases underwent the total PTX (TPTX) while 35 cases underwent the total PTX with autotransplantation (TPTX+AT). The PTXs were performed successfully in 47/50 (94.0%) patients. After the PTX, the bone pain and skin itching were alleviated, 3 cases had the temporary injury of recurrent laryngeal nerve and the hypoparathyroidism was found in 1 case. The levels of postoperative serum iPTH, calcemia, and phosphorus were lower than those at the preoperative level, the differences were statistically significant (P<0.050). The postoperative hypocalcemia was frequently seen in 38/50 (76.0%) patients, and it was effectively controlled by the intravenous calcium. After the follow-up for 3 months, the SHPT recurred in 5 cases (10.0%), of whom 3 cases underwent the TPTX+AT. The relapse rate in 12 months after the operation was 9.1% (2/22). There were no statistical differences among the three PTXs methods in the operation successful rate (χ2=3.351, P=0.211) and relapse rates in 3 months (χ2=1.321, P=0.753) and 12 months (χ2=1.794, P=0.411) after the operation. Conclusions Operations of SPTX, TPTX, and TPTX+AT are safe and effective therapeutic methods for uremic SHPT, which can significantly improve biochemical indicators and quality of life of patients. In China, the most commonly used operation method is TPTX+AT rather than SPTX and TPTX.

关键词: 尿毒症; 继发性甲状旁腺功能亢进; 甲状旁腺切除术; 复发; 低钙

Key words: uremia; secondary hyperparathyroidism; parathyroidectomy; relapse; hypocalcemia

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