摘要
目的探讨甲状旁腺全切加微量甲状旁腺自体移植术（total parathyroidectomy with autotransplantation，tPTX＋AT）在慢性肾功能衰竭继发甲状旁腺功能亢进（secondary hyperparcthyroidism, SHPT）患者外科治疗中的安全性及有效性。方法回顾性分析2010年4月至2015年10月在济南军区总医院甲状腺乳腺外科接受tPTX＋AT的149例慢性肾衰竭SHPT患者的手术前后临床资料，随访6个月至6年血清全段甲状旁腺素、血钙、血磷及临床症状变化情况等。结果149例接受手术的患者共切除598枚甲状旁腺，145例术后第2天肌肉骨骼疼痛、皮肤瘙痒的症状缓解或消失，4例1周后逐渐缓解。术后第1天iPTH（89.67±180.61）ng/L、血清磷（1.74±0.52）mmol/L、血清钙（2.07±0.32）mmol/L，均较术前下降，差异有统计学意义（P〈0.001），术后6、36及60个月血清钙、磷及iPTH水平相近（P〉0.05）。2例在术后出现病理性骨折，随访期间患者无持续性骨骼剧烈疼痛及皮肤瘙痒。2例术后处于SHPT持续状态。6例复发，其中5例接受再次手术，1例临床随诊。1例术后13个月死于肺部感染。结论tPTX＋AT应用于内科治疗无效的中晚期慢性肾功能衰竭SHPT患者安全有效。
ObjectiveTo evaluate the clinical safety and effectiveness of total parathyroidectomy with autotransplantation on the chronic renal failure （CRF） patients who are suffering from severe secondary hyperparathyroidism （SHPT） .MethodsA retrospective analysis was performed on 149 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Apr. 2010 to Oct. 2015. The changes of clinical symptoms, parathyroid hormone, calcium and phosphate blood levels were followed up during 6 months to 6 years.Results598 parathyroid glands were obtained form 149 patients who underwent surgical resection. Musculoskeletal pain and skin itching relieved or disappeared in 145 cases the 2nd day after operation, while these symptoms gradually relieved one week after operation for 4 cases. Serum intact parathyroid hormone （iPTH） was 89.67±180.61, serum phosphate 1.74±0.52, and serum calcium 2.07±0.32 the 1st day after operation, and they all decreased compared with those before operation （P〈0.001） . Serum calcium, phosphorus and iPTH levels were similar at 6, 36 and 60 months after operation （P〉0.05） . Two patients had pathological fracture after operation. No persistent bone pain or skin itching was found during the follow-up period. Two patients had secondary hyperparathyroidism. Six patients had recurrence, among whom five underwent surgery again, and one patient had clinical follow-up. One patient died of pulmonary infection at 13 months after operation.ConclusionTotal parathyroidectomy with autotransplantation were applied to ineffective medical treatment for advanced secondary hyperparathyroidism in patients with chronic renal failure.
作者
周鹏
贺青卿
庄大勇
郑鲁明
范子义
朱见
岳涛
于芳
侯蕾
Zhou Peng, He Qingqing, Zhuang Dayong, Zheng Luming, Fan Ziyi, Zhu Jian, Yue Tao, Yu Fang, Hou Lei(Department of Thyroid and Breast Surgery, the General Hospital of Jinan Military Command of PLA, Jinan 250031, Chin)
出处
《中华内分泌外科杂志》
CAS
2018年第1期34-38,50,共6页
Chinese Journal of Endocrine Surgery
基金
中国博士后科学基金第三批特别资助项目（No.201003759）
