摘要
目的 观察甲状旁腺切除术治疗尿毒症继发性甲状旁腺功能亢进症(SHPT)的临床疗效和术后并发症。方法 回顾性分析2016年10月至2018年3月在安徽医科大学附属安庆医院接受甲状旁腺切除术的52例SHPT患者的临床资料,观察术前及术后不同时期(1d、3d、7d、1个月、3个月)血钙、血磷、全段甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)的变化,以及临床症状的缓解和术后并发症、复发情况。结果 52例患者均顺利完成手术。围手术期无死亡病例。随访期未发现复发病例。术后3例患者持续性甲状旁腺功能亢进。49例患者术后血钙、血磷、iPTH、ALP均显著下降,与术前比较差异有统计学意义(P<0.05)。术后所有患者骨痛、皮肤瘙痒、失眠、肌无力等症状均得到不同程度的缓解。术后1例患者发生甲状旁腺功能减退,39例患者发生低钙血症,经积极口服及静脉补充钙剂后均未出现明显的临床症状。结论 甲状旁腺切除术治疗尿毒症SHPT安全、有效,能迅速降低SHPT患者高水平的iPTH,改善钙磷代谢紊乱,同时临床症状明显缓解。
Objective To observe the clinical efficacy and postoperative complications of parathyroidectomy in the treatment of uremic secondary hyperparathyropathy(SHPT). Methods The clinical data of 52 patients with SHPT who underwent parathyroidectomy in Anqing Hospital Affiliated to Anhui Medical University from Oct. 2016 to Mar. 2018 were retrospectively analyzed.were observed.The changes of serum calcium,phosphorus,whole parathyroid hormone(iPTH) and alkaline phosphatase(ALP),as well as the relief of clinical symptoms,postoperative complications and recurrence in the preoperative and postoperative periods(1 d,3 d,7 d,1 m,3 m) were observed. Results All the 52 patients completed the operation successfully.There was no death in perioperative period. No recurrent cases were found during the follow-up period .After operation,3 patients had persistent hyperparathyropathy.The levels of serum calcium, phosphorus,iPTH and ALP were significantly decreased in 49 patients after operation, and the differences were statistically significant compared with those before operation( P <0.05).After operation,bone pain,skin pruritus,insomnia,muscle weakness and other symptoms were relieved to varying degrees.After operation,1 patient developed hypoparathyropathy and 39 patients developed hypocalcemia.After active oral administration and intravenous calcium supplementation,there were no obvious clinical symptoms. Conclusion Parathyroidectomy is safe and effective in the treatment of uremic SHPT,which can rapidly reduce the high level of iPTH in patients with SHPT and improve the disorder of calcium and phosphorus metabolism,as well as relieve the clinical symptoms obviously.
作者
端靓靓
刘伟
施杰
黄小抗
韩久怀
张璟
DUAN Liangliang;LIU Wei;SHI Jie;HUANG Xiaokang;HAN Jiuhuai;ZHANG Jing(Department of Nephrology,Anqing Hospital Affiliated to Anhui Medical University,Anqing 246001,China)
出处
《医学综述》
2019年第16期3299-3303,共5页
Medical Recapitulate
