中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (04): 238-240.doi: 10.3969/j.issn.1671-4091.2018.04.006

• 综述 • 上一篇    下一篇

不同甲状旁腺切除术式对持续或复发甲状旁腺功能亢进的影响

杜书同1,马伟华1,赵淑丽1,闫树河1   

  1. 1. 沧州市人民医院肾内科
  • 收稿日期:2017-10-27 修回日期:2018-01-19 出版日期:2018-04-12 发布日期:2018-04-12

Factors affecting postoperative recurrence after parathyroidectomy in sever secondary hyperparathyroidism patients

  • Received:2017-10-27 Revised:2018-01-19 Online:2018-04-12 Published:2018-04-12

PDF

596

摘要： 【摘要】继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)是慢性肾衰竭患者的主要并发症之一，严重影响的患者的预后，对于药物不可控制的严重SHPT，即需要甲状旁腺切除术(parathyroidectomy,PTX)，PTX 可有效的缓解患者的症状和体征，降低患者的心血管及全因死亡率，但术后复发率非常高。PTX 术前影像学检查、术式的选择、胸腺切除与否均是影响术后复发的关键因素。结合既往的研究和我们的临床经验，选择合适的术前影像学定位对降低术后复发率有一定的辅助作用，目前甲状旁腺切除术括3 种术式：甲状旁腺次全切除(subtotal parathyroidectomy,SPTX)，全甲状旁腺切除术+甲状旁腺自体移植(total parathyroidectomy with autotransplantation,TPTX+AT)，全甲状旁腺切除术(total parathyroidectomy,TPTX)，虽然国内外尚无强有力的证据证明哪一种术式更优，但我们认为TPTX 应作为首选术式，可有效降低术后复发率，必要时行延时自体移植避免术后并发症的发生，如果术中未探查到或切除所有的甲状旁腺，胸腺切除对于降低术后复发率是有效的。

关键词: 继发性甲状旁腺亢进, 甲状旁腺切除术, 复发, 胸腺切除

Abstract: 【Abstract】Secondary hyperparathyroidism (SHPT) is one of the major complications in chronic renal failure patients, and seriously affects their prognosis. Parathyroidectomy (PTX) is necessary when serious SHPT is refractory to medical treatment. PTX can effectively ameliorate the signs and symptoms of SHPT, survival rate and the quality of life. Pre-operative imaging, surgical modality and thymectomy are the key factors influencing the postoperative recurrence. According to current literature and our own experiences, preoperative imaging for localization is occasionally helpful to reduce postoperative recurrence. Operative approaches include subtoatal PTX, total PTX with autotransplantation and PTX without autotransplantation. Although there is no strong evidence to prove which operation is the best, we think total PTX is the first choice. Total PTX can effectively reduce postoperative recurrence. Delayed parathyroid autotransplantation may be necessary to avoid complications. Thymectomy is effective in the cases that four glands are not identified and removed.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Recurrence, Thymectomy