中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (05): 285-288.doi: 10.3969/j.issn.1671-4091.2016.05.008

• 临床研究 • 上一篇    下一篇

甲状旁腺全切除加前臂移植术治疗继发性甲状旁腺功能亢进患者的临床疗效观察

侯爱珍1,肖观清1,孔耀中1,陈伟雄1,张剑利1   

  1. 广东省佛山市第一人民医院
  • 收稿日期:2015-10-20 修回日期:2016-03-03 出版日期:2016-05-12 发布日期:2016-05-19

Clinical effect of total parathyroidectomy combined with forearm autograft in uremic patients complicated with secondary hyperparathyroidism

  • Received:2015-10-20 Revised:2016-03-03 Online:2016-05-12 Published:2016-05-19

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摘要： 目的观察甲状旁腺全切除加自体前臂移植术(total parathyroidectomy+autotransplantation，tPTX+AT)治疗尿毒症并发继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)的安全性及临床疗效。方法选择2014 年4 月～2015 年10 月随访大于3 个月难治性肾性SHPT 患者15例，观察手术并发症、术后复发及术前后全段甲状旁腺激素(intact parathyroid hormone，iPTH)、血钙、磷及相关临床症状的变化。结果15 例中全部成功切除甲状旁腺14 例，成功率93.3%，1 例患者因纵隔甲状旁腺异位，未能全部切除干净，围手术期无死亡发生。1 例患者术后6 月复发，复发率(7.14%)。手术成功的14 例患者血iPTH 术后6 月较术前显著下降[(122.47±78.74)ng/L 比(2017.21±561.52)ng/L，t=6.460,P＜0.001]；血磷术前(2.37±0.70)mmol/L，术后6 月显著下降至(1.41±0.98)mmol/L(t=2.172，P= 0.045)；术前与术后6 月血钙比较无显著差异[(2.51±0.25)mmol/L 比(2.34±0.27)mmol/L,t=1.246, P=0.231]；术后6 月血碱性磷酸酶水平较术前显著下降[(205.32 ±134.63)IU/L 比(534.61±321.12)IU/L,t=2.443,P=0.034]；术后6 月血红蛋白水平较术前显著升高[(118.8±9.98)g/L 比(108±21.62)g/L, t=-0.951,P=0.046]；术后6 月血白蛋白水平较术前升高[(40.25±3.45)g/L 比(38.01±5.83)g/L,t=-1.022,P=0.042]；手术成功的14 例患者术后当日开始骨痛及瘙痒症状可缓解甚至消失，健康调查简表(the MOS item short from health survey,SF-36)生活质量评分术后6 月较术前显著提高(120.85±25.50 比80.91±15.62，t=-0.737，P=0.047)。结论tPTX+AT 治疗尿毒症并发的SHPT 是一种安全有效的手段，手术风险较低，术后患者生化指标及骨痛、瘙痒、生活质量显著改善。而避免术后复发的关键是做到真正的甲状旁腺全切除及选取适量的弥漫增生的甲状旁腺行自体前臂移植。

关键词: 继发性甲状旁腺功能亢进症, 甲状旁腺全切除术, 尿毒症

Abstract: 0bjective To observe the clinical effect of parathyroidectomy (PTX) combined with autograft in forearm in end-stage renal disease (ESRD) patient complicated with refractory secondary hyperthyroidism (SHPT). Methods We retrospectively reviewed 15 MHD patients treated with PTX during the period from Apr. 2014 to Oct. 20l5. Symptoms before and after operation, operation complications, pathological findings of the surgical samples, biochemical parameters, serum iPTH, recurrence of SHPT, and prognosis were analyzed. Results Total PTX was successfully performed in 14 of the 15 cases (93.3%), and one patients with ectopic parathyroid in mediastinum failed to total removal of the gland. No patient died after the operation. SHPT recurred in one patient after 6 months (7.14%). In the 14 patients after total PTX for 6 months, serum iPTH decreased from 2017.21±561.52 ng/L to 122.47±78.74 ng/L (t=-6.460, P＜0.001), serum phosphorus decreased from 2.37 ± 0.70 mmol/L to 1.41 ± 0.98 mmol/L (t=- 2.172, P=0.045), serum calcium changed insignificantly from 2.51±0.25 mmol/L to 2.34±0.27 mmol/L (t=-1.246, P=0.231), ALP decreased from 534.61 ± 321.12 IU/L to 205.32 ± 134.63 IU/L (t=- 2.443, P=0.034), hemoglobin increased from 108 ±21.62 g/L to 118.8±9.98 g/L (t=0.951, P=0.046), ALB increased from 38.01±5.83 g/L to 40.25±3.45 g/L (t=1.02, P=0.042), bone pain and itching alleviated or disappeared, and the SF- 36 score for quality of life increased from 80.91±15.62 to 120.85±25.50 (t=-0.737, P=0.047). Conclusions PTX is a relatively safe and effective method for the treatment of MHD patients with SHPT. PTX can significantly improve biochemical indices, bone pain, itching and quality of life. Total PTX and autograft of a part of the surgical tissue in forearm is an important measure to prevent the recurrence of SHPT.

Key words: Hyperparathyroidism, Parathyroidectomy, Uremia