外科理论与实践 ›› 2023, Vol. 28 ›› Issue (06): 568-573.doi: 10.16139/j.1007-9610.2023.06.14

• 综述 • 上一篇    下一篇

甲状旁腺切除术治疗继发性甲状旁腺功能亢进症的争议与进展

王强, 查斯洛 综述, 张伟 审校   

  1. 海军军医大学第二附属医院甲乳疝外科,上海 200003
  • 收稿日期:2022-04-16 出版日期:2023-11-25 发布日期:2024-03-04
  • 基金资助:
    上海市卫生健康委员会临床研究项目(202140514)

Controversy and progress in parathyroidectomy for the treatment of secondary hyperparathyroidism

WANG Qiang, ZHA Siluo, ZHANG Wei   

  1. Department of Thyroid Breast and Hernia Surgery, Chang Zheng Hospital, Naval Medical University, Shanghai 200003, China
  • Received:2022-04-16 Online:2023-11-25 Published:2024-03-04

摘要:

继发性甲状旁腺功能亢进症是长期透析病人的常见并发症之一。虽然可以选择拟钙剂、维生素D类似物等药物内科治疗方案,但对于药物治疗反应较差的难治性病人仍可选择甲状旁腺切除术作为治疗手段。目前相关术式包括甲状旁腺次全切除术、甲状旁腺全切除术、甲状旁腺全切除术联合自体移植和甲状旁腺肃清术。由于本病是透析病人体内钙磷和维生素D代谢紊乱刺激甲状旁腺增生所致,因此手术切除甲状旁腺的临床目标参数具有一定的不可控性,外科治疗策略也存在争议。但随着临床数据的积累、新观念的涌现和新技术的更新,合理的药物选择和恰当的手术干预将进一步提升治疗效果和安全性。

关键词: 继发性甲状旁腺功能亢进, 甲状旁腺切除术, 钙磷代谢紊乱

Abstract:

Secondary hyperparathyroidism is one of common complications of long-term dialysis patients. Although medical treatment schemes such as calcimimetics and vitamin D analogues can be selected, patients refractory to drug treatment can still refer to parathyroidectomy as a treatment choice. At present, the surgical treatment include subtotal parathyroidectomy, total parathyroidectomy with or without auto-transplantation and purge parathyroidectomy. Because the etiology of this disease is related to hyperplasia of parathyroid tissue stimulated with metabolic disorder of calcium, phosphorus and vitamin D in dialysis patients, the course of disease and target indexes of surgical treatment might still be difficult to control, and there still lies controversies in surgical therapeutic strategy. However, with updating of clinical data, the emergence of new concepts and the introduction of new technologies, reasonable drug selection and appropriate timing of surgical intervention will further improve the treatment efficacy and safety.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Metabolic disorder of calcium and phosphorus

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