摘要
目的探讨甲状旁腺全切并自体前臂移植术(PTX+AT)对难治性继发性甲状旁腺功能亢进(SHPT)患者骨代谢的影响。方法分析终末期肾病合并SHPT,成功行PTX+AT并能按照要求定期随访6个月的患者30例,收集患者术前和术后1、3及6个月血清钙、磷、全段甲状旁腺激素(i PTH)及碱性磷酸酶,测量患者术前和术后6个月头颅额部兴趣区CT值,统计并分析结果。结果 1 30例患者全部成功手术,术后骨痛、皮肤瘙痒、不宁腿症状均缓解,未再出现新发骨折和异位钙化;2术后血钙、磷及i PTH较术前降低,差异有统计学意义(P<0.01),术后半年头颅兴趣区CT值较术前升高,差异有统计学意义(P<0.05);3术后低钙血症发生率较高,达76.7%(23/30),积极静脉、口服补钙后19例纠正;2例发生一过性声音嘶哑,随访3个月内恢复;随访半年内,无复发病例。结论 PTX+AT是治疗SHPT的一种安全有效手段,可以纠正钙磷代谢紊乱,改善患者骨代谢,增加骨量,降低骨折发生率。
Objective To observe the effect of total parathyroidectomy with autotransplantation （ PTX ＋AT ） on bone metabolism in patients with severe secondary hyperparathyroidism （ SHPT） . Methods 30 patients who un-derwent PTX＋AT for ESRD and SHPT were followed-up over a 6-month period in this study. Blood parameters consisting of calcium, phosphorus, intact parathyroid hormone （ iPTH） , alkaline phosphatase （ ALP） were collect-ed at different time before and after surgery（1, 3, 6 months）. Concomitantly, the interest region CT value of crani-al frontal was measured before and after surgery（6 months） . All patients signed informed consent. Results ①Of all the 30 cases undergone PTX＋AT, bone pain, itching and restless legs symptom were greatly improved in most of the patients. Fractures and ectopic calcification did not happen after the operation. ② Postoperative blood bio-chemistry and frontal CT value：significant reductions in serum calcium （ P〈0. 01 ） , phosphorus （ P〈0. 01 ） and iPTH （P〈0. 01） levels occurred after surgery, compared with preoperative values. Six months after surgery frontal CT value increased than those in preoperative period （ P〈0. 05 ） .③ Postoperative complications and recurrence：postoperative hypocalcemia was frequently seen in 23 cases （76. 7%） and it could be effectively controlled by post-operative calcium administration. Temporary injury of recurrent laryngeal nerve was found in 2 patients who recov-ered 3 months after operation. Follow-up of six months, no patients relapsed after surgery. Conclusion PTX＋AT for SHPT in ESRD patients can ameliorate bone metabolism, and enhance bone mass and reduce the incidence of fractures. In conclusion, PTX＋AT is safe, economical and effective in the treatment for renal refractory secondary hyperthyroidism.
出处
《安徽医科大学学报》
CAS
北大核心
2015年第7期1008-1011,共4页
Acta Universitatis Medicinalis Anhui
基金
安徽省高校自然科学基金研究项目(编号:KJ2013Z155)
