中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (11): 741-745.doi: 10.3969/j.issn.1671-4091.2017.011.006

• 临床研究 • 上一篇    下一篇

超声引导下微波消融术治疗继发性甲状旁腺功能亢进的临床观察

廖琪1,刘金伟2,黄江燕1,胡广1,邹贵勉1,眭维国1   

  1. 解放军第一八一医院1肾脏科全军器官移植与透析治疗中心，广西代谢性疾病研究重点实验室， 2超声科
  • 收稿日期:2017-05-19 修回日期:2017-09-10 出版日期:2017-11-12 发布日期:2017-10-27
  • 通讯作者: 邹贵勉zougm2004@126.com E-mail:zougm2004@126.com

The efficiency of ultrasound guided microwave ablation therapy for secondary hyperparathyroidism

  • Received:2017-05-19 Revised:2017-09-10 Online:2017-11-12 Published:2017-10-27

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摘要： 目的探讨超声引导下微波消融术(microwave ablation,MWA)治疗尿毒症继发性甲状旁腺功能亢进(secondary hyperparathyroidism, SHPT)的临床疗效和安全性。方法选择18 例尿毒症SHPT 的血液透析患者，在超声引导下进行甲状旁腺微波消融术。观察患者术前、术后2 小时、1 天、1 周、1月、6 月和1 年的甲状旁腺激素(parathyroid hormone,PTH)、血钙、血磷、碱性磷酸酶(alkaline phosphatase,ALP)水平的变化。同时观察临床症状的改善、并发症的发生情况。结果18 例患者共消融甲状旁腺56 枚，术后2h、1d、1 周、1 月、6 月和1 年PTH 水平分别为(460.47±473.79)ng/L、(448.92±306.36)ng/L、(354.69 ± 325.87)ng/L、(275.60 ± 232.95)ng/L、(304.60 ± 277.67)ng/L、(293.76 ±277.68ng/L)较术前(1593.72±567.40)ng/L 明显下降，差异有统计学意义(t=6.504，P＜0.001；t=5.849，P＜0.001；t=7.976，P＜0.001；t=5.745，P＜0.001；t=4.757，P＜0.001；t=3.467，P=0.002)，术后2小时至术后1 年PTH 差异无统计学意义(F=0.194,P= 0.964)；10 例患者发生低钙血症(55.56%)，经积极补钙后能维持血钙在(1.96±0.16)mmol/L。3 例出现内瘘闭塞(16.67%)，3 例患者出现一过性喉返神经损伤(16.67%)。结论超声引导下微波消融术是一种治疗SHPT 安全、有效的方法。

关键词: 继发性甲状旁腺功能亢进, 超声, 微波消融术

Abstract: Objective To explore the safety and efficacy of microwave ablation (MWA) in uremic patients with secondary hyperparathyroidism (SHPT). Methods Eighteen patients with end-stage renal disease and SHPT received microwave ablation guided by color Doppler ultrasound. Laboratory tests including serum parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) were conducted before the therapy and after the therapy for 2 hours, one day, one week, one month, 6 months and one year. Improvement of SHPT- related symptoms after ablation and complications during and after MWA were recorded. Results Fifty-six hyperparathyroidism nodules in 18 patients were treated by MWA. In patients treated with MWA, serum PTH was 460.47±473.79 ng/L after 2 hours, 448.92±306.36 ng/L after one day, 354.69±325.87 ng/L after one week, 275.60±232.95 ng/L after one month, 304.60±277.67 ng/L after 6 months and 293.76±277.68 ng/L after one year, significant different as compared with the value before treatment (1593.72±567.40 ng/L; t= 6.504, 5.849, 7.976, 5.745, 4.757 and 3.467, respectively; P＜0.001 for all the PTH values). However, there was no significant difference between the PTH levels after MWA (F=0.194, P=0.9640). After MWA, hypocalcaemia occurred in 10 patients (55.56%) and was rapidly corrected with calcium supplement, arteriovenous fistula occlusion was found in 3 patients (16.67%), and transient hoarseness happened in 3 patients (16.67%). Conclusion MWA is a safe and effective measure to manage SHPT.

Key words: secondary hyperparathyroidism, ultrasound, microwave ablation