中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (08): 505-508.doi: 10.3969/j.issn.1671-4091.2020.08.001

• 临床研究 •    下一篇

行甲状旁腺全切术的265 例继发性甲状旁腺功能亢进症的临床特征分析

毕婷1,冯晓东1,程广明1,张巍1,唐裕福1,王春晖1,白思嘉1,郭帅1   

  1. 1北部战区总医院肝胆外科
  • 收稿日期:2020-03-09 修回日期:2020-05-12 出版日期:2020-08-12 发布日期:2020-08-12
  • 通讯作者: 冯晓东 981613149@qq.com E-mail:18741658267@163.com
  • 基金资助:
    辽宁省自然科学基金指导计划(20180551225)

Clinical analysis of the 265 secondary hyperparathyroidism cases treated with total parathyroidectomy

  1.  1Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang 110016, China
  • Received:2020-03-09 Revised:2020-05-12 Online:2020-08-12 Published:2020-08-12

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摘要： 【摘要】目的     分析行甲状旁腺全切术 ( total parathyroidectomy, t-PTX ) 的265例继发性甲状旁腺功能亢进症 ( secondary hyperparathyroidism，SHPT )的临床特征。方法回顾性总结分析北部战区总医院肝胆外科2018 年1 月～2019 年12 月行t-PTX 术的SHPT 患者，统计其临床表现、检查检验结果、病理结果等。结果265 例患者中SHPT 病程(3.07±2.13)年，有5例异位旁腺(1.89%)，切除4 枚旁腺220例(83.02%)，术后病理提示结节样增生182 例、腺瘤样增生6 例、二者结合64 例，218 例患者术后出现低钙血症(82.26%)，住院期间静脉高浓度补钙(557.86±376.20)ml，术后6 例复发(22.64%)，围手术期死亡2例(0.75% )，术前甲状旁腺激素(parathormone,PTH) (1729.15±345.18)pg/ml、血清钙(calcium,CA)(2.43±0.19)mmol/L、磷(phosphore,P) (2.38±0.52)mmol/L，术中PTH(286.97±179.25)pg/ml，术后PTH、CA、P 水平均较术前显著降低(t 值分别为6.630，- 2.965，- 3.412；P 值分别为＜0.001，0.005，0.001)。246 人存在骨痛(2.30±1.95)年，骨痛评分(5.08±2.65)分；骨密度测量34 例(12.83%)骨量正常、105 例(39.62%)骨量减少、126 例(47.55%)骨质疏松；197 人(74.34%)存在瘙痒(2.13±1.25)年，瘙痒评分(3.58±1.19)分，术后6 月骨痛、瘙痒评分明显改善(t 值分别为7.897，2.542；P 值分别为＜0.001，0.014)。结论t-PTX 是治疗SHPT 的安全有效的方法，多数SHPT 患者骨痛、瘙痒严重，以结节样病变为主，术后可明显改善，可发生严重低钙血症，在治疗中应予以重视。

关键词: 继发性甲状旁腺功能亢进症, 甲状旁腺全切除术, 临床特征

Abstract: 【Abstract】Objective To analyze the clinical characteristics of the 265 secondary hyperparathyroidism (SHPT) patients who underwent total parathyroidectomy (t-PTX). Methods Clinical manifestations, laboratory results and pathological changes of the SHPT patients who underwent t-PTX from January 2018 to December 2019 were retrospectively analyzed. Results In the 265 patients, the SHPT lasted 1-9 (3.07±2.13) years, 5 had heterotopic paraglands (1.89%), 220 had 4 paraglands removed (83.02%), 182 had nodular hyperplasia, 6 had adenomatous hyperplasia, and 64 had both types of hyperplasia. After operation, 218 patients
developed hypocalcemia (82.26%). During hospitalization, 557.86±376.20 ml of higher concentration calcium was supplemented intravenously. After operation, 6 patients recurred (22.64%), and 2 patients died in peri-operation period (0.75%). Before operation, serum PTH was 588～2934 (1729.15±345.18) pg/ml, Ca was 1.95～2.93 (2.43±0.19) mmol/L, and P was 1.3～3.59 (2.38±0.52) mmol/L; during operation, PTH decreased to 49.00～895.00 (286.97±179.25) pg/ml; after operation, PTH, CA and P levels decreased significantly (t=6.630, - 2.965 and - 3.412 respectively; P＜0.001, 0.005 and 0.001 respectively). Bone pain was
found in 246 patients (92.83%), with the bone pain course of 0~8 years (2.30±1.95) years and bone pain score of 0～10 (5.08 ± 2.65) points. Bone density measurement found normal bone mass in 34 patients (12.83%), lower bone mass in 105 patients (39.62%), and osteoporosis in 126 patients (47.55%). Skin itch was found in 197 patients (74.34%), with the itch course of 0~8 years (2.13±1.25) years and itch score of 0～10 (3.58±1.19) points. After operation 6 morrths, bone pain and itch improved significantly (t=7.897 and 2.542 respectively; P<0.001 and 0.014 respectively). Conclusions t-PTX is a safe and effective method to treat SHPT. Most SHPT patients have severe bone pain and itching. The pathological changes of parathyroids were mainly nodular lesions. SHPT can be significantly improved by t-PTX surgery. Severe hypocalcemia may occur after surgery, which should be carefully monitored.

Key words: Secondary hyperparathyroidism, Total parathyroidectomy, Clinical characteristic

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