摘要
慢性肾功能衰竭长期透析的患者体内钙磷代谢紊乱可引起甲状旁腺代偿性增生及体内全段甲状旁腺激素(intact parathyroid hormone,iPTH)增加,称为肾性甲状旁腺功能亢进(renal hyperparathyroidism,HPT)或继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT),临床可表现为高甲状旁腺激素、高钙或低钙血症、持续性高磷。可导致骨骼系统、神经精神系统、血液系统及心脑血管系统疾病,影响生存质量及寿命。2017年全球肾脏病指南推荐慢性肾脏病(chronic kidney disease,CKD)3~5期合并药物治疗无效的严重甲状旁腺功能亢进,建议行甲状旁腺切除术,但是术后复发率问题影响着手术的进一步推广。尽管超声波和放射性核素扫描技术在过去几年已经成熟很多,但仍无法确保在术前完全定位全部甲状旁腺,尤其是增生不明显的甲状旁腺。相较于全切术,次全切和全切加自体移植的复发率更高,所以全切术更多的被推荐用于预防复发。除此之外完善术前定位、胸腺切除、术中甲状旁腺激素监测以及术中神经监测也有助于降低术后复发。
Disturbance of calcium and phosphorus metabolism in chronic renal failure patients with long-term dialysis can cause compensatory hyperplasia of parathyroid gland and the increase of intact parathyroid hormone(iPTH)known as renal hyperparathyroidism(HPT)or secondary hyperparathyroidism(SHPT),clinical manifestations can include high parathyroidin,high calcium or hypocalcemia,and persistent high phosphorus.It can lead to diseases of skeletal system,neuropsychiatric system,blood system and cardio-cerebrovascular system,seriously affecting the quality of life and life span.The 2017 Global Guidelines for Kidney Disease recommend Chronic Kidney Disease(CKD)stage 3-5 complicated with severe hyperparathyroidism that does not respond to drug therapy,and parathyroidectomy is recommended.The problem of postoperative recurrence rate affects the further promotion of surgery.Although ultrasound and radionuclide scanning techniques have become more sophisticated in the past few years,it is still not possible to ensure complete preoperative localization of all parathyroids,especially those with less hyperplasia.The recurrence rate of subtotal resection and total resectionplus autologous transplantation is higher than that of total resection,so total resection is more recommended for the prevention of recurrence.In addition,the improvement of preoperative localization,thymotomy,intraoperative parathyroid hormone monitoring and intraoperative nerve monitoring also contributed to the reduction of postoperative recurrence.
作者
金秋
梁玉龙
JIN Qiu;LIANG Yulong(Department of General Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050000,China)
出处
《医学研究与教育》
CAS
2022年第1期41-48,共8页
Medical Research and Education
关键词
继发甲状旁腺功能亢进
复发率
肾移植
甲状旁腺激素监测
secondary hyperparathyroidism
recurrence rate
renal transplantation
intraoperative parathyroid hormone
