甲状旁腺全切除联合自体前臂移植治疗继发性甲状旁腺功能亢进

doi:10.16139/j.1007-9610.2022.04.014

摘要/Abstract

摘要：

目的：分析甲状旁腺全切除联合自体前臂移植术治疗继发性甲状旁腺功能亢进的临床疗效。方法：研究本院2017年1月至2020年12月间行甲状旁腺全切除联合自体前臂移植术26例病人术后的血钙、血磷、全段甲状旁腺激素、碱性磷酸酶及临床症状改善情况,分析手术效果。本研究病人均为终末期肾病持续性透析治疗并发继发性甲状旁腺功能亢进。结果：共切除甲状旁腺105枚。所有病人骨痛、皮肤瘙痒症状均明显改善或消失,术后3个月、6个月的血钙、血磷、碱性磷酸酶、全段甲状旁腺激素均较术前明显降低(P<0.05)。手术均成功。术后复发1例(3.85%)。术后并发症发生2例(7.69%)。结论：甲状旁腺全切除联合自体前臂移植术临床疗效好,是治疗难治性继发性甲状旁腺功能亢进安全有效的方法。

关键词: 甲状旁腺激素, 甲状旁腺功能亢进, 继发性, 甲状旁腺切除, 自体移植

Abstract:

Objective To analyze the clinical effect of total parathyroidectomy with forearm autotransplantation on secondary hyperparathyroidism. Methods From January 2017 to December 2020, calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase and clinical symptoms of 26 patients who received total parathyroidectomy with forearm autotransplantation in our hospital were studied. The patients with end-stage renal disease in this study had persistent dialysis in the treatment of secondary hyperparathyroidism before admission. Results A total of 105 parathyroid glands of all patients were removed. The symptoms including ostalgia and itch of skin were improved or removed in all cases. Amount of calcium, phosphorus, alkaline phosphatase and intact parathyroid hormone in serum decreased significantly post-operative 3 and 6 months than before (P<0.05). The operation was performed all successful. One case(3.85%) recurred with postoperative complications in 2 cases(7.69%). Conclusions Total parathyroidectomy with forearm autotransplantation would be safe and effective for the treatment of refractory secondary hyperparathyroidism.

Key words: Parathyroid hormone, Hyperparathyroidism, Secondary, Parathyroidectomy, Autotransplantation

中图分类号:

R653

李荣国, 张伟军, 徐婷燕, 杜琪威. 甲状旁腺全切除联合自体前臂移植治疗继发性甲状旁腺功能亢进[J]. 外科理论与实践, 2022, 27(04): 346-350.

LI Rongguo, ZHANG Weijun, XU Tingyan, DU Qiwei. Total parathyroidectomy with forearm autotransplantation in treatment of secondary hyperparathyroidism[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 346-350.

图/表 2

参考文献 19

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时间	血钙 (mmol/L)	血磷 (mmol/L)	血碱性磷酸酶 (U/L)	iPTH (pmol/L)
正常值	2.11~2.52	0.85~1.51	45~125	12~88
术前	2.32±0.32	2.05±0.37	340±317	1 772±800
术后3个月	2.04±0.22	1.00±0.26	212±147	85±320
6个月	1.97±0.37	1.09±0.38	88±43	36±27
F值	6.196	75.500	5.772	83.730
P值	0.003	<0.001	0.005	<0.001

时间	骨痛VAS	瘙痒VAS	睡眠SRSS
术前	7.54±1.83	5.24±2.56	28.53±10.28
术后1个月	4.26±2.85	3.12±1.72	18.31±8.36
t值	6.219	4.219	16.521
P值	<0.05	<0.05	<0.05