中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (01): 44-47.doi: 10.3969/j.issn.1671-4091.2017.01.011

• 临床研究 • 上一篇    下一篇

不同外科术式治疗尿毒症继发性甲状旁腺功能亢进的效果分析

于婵媛1,杨立志1,窦海川1,张洋1,王红月1   

  1. 吉林大学第一附属医院
  • 收稿日期:2016-07-14 修回日期:2016-11-06 出版日期:2017-01-12 发布日期:2017-01-12
  • 通讯作者: 王红月 why_changchun@sina.com E-mail:why_changchun@sina.com

Analyses of different parathyroidectomy surgical modalities on the treatment of secondary hyperparathyroidism in uremic patients

  • Received:2016-07-14 Revised:2016-11-06 Online:2017-01-12 Published:2017-01-12

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摘要： 目的研究甲状旁腺全切、次全切及全切加前臂移植手术对尿毒症继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)患者的临床疗效。方法对2014 年4 月～2015 年4 月在医院接受甲状旁腺切除术治疗的尿毒症SHPT 33 例进行回顾性分析，比较3 种术式对术后l 周、1 月、6 月的全段甲状旁腺激素(intact parathyroid hormone，iPTH)、血钙、血磷的影响，对骨关节痛、皮肤瘙痒等症状的缓解情况及手术并发症。结果①33 例手术均成功，患者骨关节痛，皮肤瘙痒及皮下软组织钙化均有不同程度缓解，以骨关节痛缓解最明显，且全切组缓解率最高，各症状缓解率均达100%；②组内比较血钙、血磷及iPTH 均较术前明显下降(全切组：血钙1 周t=3.922，P＜0.001；1 月t=3.463,P＜0.001；6 月t=3.114，P=0.006；血磷1 周t=8.871，P＜0.001；1 月t=8.021, P＜0.001；6 月t=7.752，P＜0.001；iPTH 1周t=8.175，P＜0.001；1 月t=8.175,P＜0.001；6 月t=6.817，P＜0.001；次全切组：血钙1 周t=4.213，P＜0.001；1 月t=3.277,P=0.004；6 月t=2.816，P=0.021；血磷1 周t=7.783，P＜0.001；1 月t=7.742,P＜0.001;6 月t=7.742，P＜0.001；iPTH 1 周t=5.933，P＜0.001；1 月t=4.875,P＜0.001; 6 月t=4.886，P＜0.001；全切+前臂移植组：血钙1 周t=3.114，P=0.006；1 月t=3.206,P=0.005;6 月t=4.027，P＜0.001；血磷1 周t=8.922，P＜0.001；1 月t= 7.811, P＜0.001;6 月t=7.774，P＜0.001；iPTH 1 周t=7.947，P＜0.001；1 月t=7.335,P＜0.001;6 月t=7.220，P＜0.001),差异具有统计学意义。组间比较血钙、血磷各时间点无统计学差异(血钙1 周：F=2.498，P=0.074；1 月：F=3.080，P=0.065；6 月：F=2.771，P=0.069；血磷1周：F=1.094，P=0.195；1 月：F= 1.933，P=0.178；6 月：F=2.011，P=0.169)。与全切组比较，次全切组术后iPTH 高,差异具有统计学意义(1 周t=6.855,P=0.006,1 月t=7.288,P=0.003，6 月t= 6.732. P=0.006)；全切+前臂移植组术后1 周iPTH 与全切组比较无区别(t=2.317,P=0.083)，术后1 月(t=6.609,P=0.008)及6月[t=5.985,P=0.011]时高于全切组。③术后无显著合并症。结论3 种术式均能有效治疗尿毒症SHPT，手术安全，3 组对血钙、血磷值影响无区别，全切组术后iPTH下降更明显。

关键词: 继发性甲状旁腺功能亢进, 尿毒症, 甲状旁腺切除术

Abstract: Objective To investigate the clinical effects of subtotal parathyroidectomy (S- PTX), total parathyroidectomy (T-PTX), and parathyroidectomy combined with autotransplantation (PTX+AT) on the secondary hyperparathyroidism (SHPT) in uremic patients. Methods A total of 33 SHPT patients treated with SPTX,
T-PTX, or PTX+AT in our hospital during the period April 2014 to April 2015 were retrospectively analyzed. The changes of intact parathyroid hormone (iPTH), serum phosphorus (P), serum calcium (Ca), bone pain and skin itch, and postoperative complications in these patients were studied after the operations. Results ① Surgical operations were successfully performed in all patients. Bone pain, skin itch, and calcification of subcutaneous soft tissue were alleviated with different degrees, with the most effectiveness on bone pain. T-PTX was the most effective modality for relief of SHPT symptoms. ②Serum Ca, P and iPTH reduced significantly after the operation for one week, one month and 6 months in all patients as compared with those before the operation (In T-PTX group, t=3.922, P＜0.001 for Ca after one week; t=3.463, P＜0.001 for Ca after one month; t=3.114, P=0.006 for Ca after 6 months; t=8.871, P＜0.000 for P after one week; t=8.021, P＜0.001 for P after one month; t=7.752, P＜0.001 for P after 6 months; t=8.175, P＜0.001 for iPTH after one week; t=8.175, P＜0.001 for iPTH after one month; t =6.817, P＜0.001 for iPTH after 6 months. In S-PTX group, t=4.213, P＜0.001 for Ca after one week; t=3.277, P=0.0041 for Ca after one month; t=2.816, P=0.021 for Ca after 6 months; t=7.783, P＜0.001 for P after one week; t=7.742, P＜0.001 for P after one month; t= 7.742, P＜0.001 for P after 6 months; t=5.933, P＜0.001 for iPTH after one week; t=4.875, P＜0.001 for iPTH after one month; t=4.886, P＜0.001 for iPTH after 6 months. In PTX+AT group, t=3.114, P=0.006 for Ca after one week; t=3.206, P=0.005 for Ca after one month; t=4.027, P＜0.001 for Ca after 6 months; t= 8.922, P＜0.001 for P after one week; t=7.811, P＜0.001 for P after one month; t=7.774, P＜0.001 for P after 6 months; t=7.947, P＜0.001 for iPTH after one week; t=7.335. P＜0.001 for iPTH after one month; t=7.220, P＜0.001 for iPTH after 6 months). Serum Ca and P after the operation for one week, one month and 6 months had no statistical significances among the 3 groups (F=2.498, P=0.074 for Ca after one week; F= 3.080, P=0.065 for Ca after one month; F=2.771, P=0.069 for Ca after 6 months; F=1.094, P=0.195 for P after one week; F=1.933, P=0.178 for P after one month; F=2.011, P=0.169 for P after 6 months). Serum iPTH levels were statistically higher in S-PTX group than in T-PTX group (t=6.855, P=0.006 after one week; t= 7.288, P=0.003 after one month, t=6.732, P=0.006 after 6 months). Serum iPTH levels had no differences after the operation for one week between PTX+AT group and T-PTX group (t=2.317, P=0.083), but were higher after the operation for one month and 6 months in PTX+AT group than in T-PTX group (t=6.609, P=0.008 after one month; t=5.985, P=0.011 after 6 months). ③No obvious complications were found after the operations. Conclusion The operations of T-PTX, S-PTX and PTX+AT are safe and can all treat uremia SHPT effectively. The reduction of serum Ca and P showed no difference among the 3 groups, but the reduction of iPTH was most effectively in T-PTX group.

Key words: secondary hyperparathyroidism, uremia, parathyroidectomy