中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (10): 685-688.doi: 10.3969/j.issn.1671-4091.2019.10.007

• 临床研究 • 上一篇    下一篇

难治性继发性甲状旁腺功能亢进外科治疗疗效分析

徐乐1 ,陈隽1,王家东1   

  1. 1.上海交通大学医学院附属仁济医院头颈外科
  • 收稿日期:2019-04-08 修回日期:2019-06-03 出版日期:2019-10-12 发布日期:2019-09-27
  • 通讯作者: 王家东drjiadongw@aliyun.com E-mail:drjiadongw@aliyun.com
  • 基金资助:
    上海交通大学“医工交叉研究基金”(YG2017QN45)

Surgical treatment of refractory secondary hyperparathyroidism

  1. 1Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
  • Received:2019-04-08 Revised:2019-06-03 Online:2019-10-12 Published:2019-09-27

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摘要： 【摘要】目的分析比较难治性继发性甲状旁腺功能亢进患者行甲状旁腺全切术+前臂自体移植及甲状旁腺次全切除的疗效。方法回顾性分析2004～2018 年在上海交通大学附属仁济医院头颈外科行手术的284 例甲状旁腺功能亢进患者，统计其术前、术后第1 日、术后6 个月血钙、甲状旁腺激素(parathyroid hormone，PTH)水平及并发症发生率，复发率等。结果2 组患者术后血钙(t1=11.340，P1＜0.001；t2=8.209，P2＜0.001)及PTH(t1=69.968，P1＜0.001；t2=67.973，P2＜0.001)指标均较术前明显下降；2 组之间术后血钙指标(t=0.491，P=0.636)无明显差异，2 组之间术后6 个月PTH 指标(t=2.412，P=0.023)存在差异。次全切组复发率27.3%，全切+移植组复发率9.92%(χ2=6.110，P=0.013)有统计学差异。结论手术治疗对难治性继发性甲状旁腺功能亢进短期疗效显著，严重并发症少见，全切+前臂移植较次全切更有利于降低术后PTH值，且复发率更低。

关键词: 继发性甲状旁腺功能亢进, 甲状旁腺切除, 前臂自体移植, 甲状旁腺激素

Abstract:

【Abstract】Objective To compare the efficacy of total parathyroidectomy with forearm-autotransplantation (tPTx + AT) and subtotal parathyroidectomy (sPTx) in patients with secondary hyperparathyroidism (SHPT). Methods We retrospectively analyzed the clinical data of 284 SHPT patients accepted the surgery in our hospital from 2004 to 2018. Preoperative and post-operative serum calcium and PTH were analyzed, and their complication rate and recurrence rate were discussed. Results Postoperative serum calcium (t=11.340, P＜0.001 for tPTx+AT; t= 8.209, P＜0.001 for sPTx) and PTH (t=69.968, P＜0.001 for tPTx+AT; t=67.973, P＜0.001 for sPTx) were significantly lower than those before operation in both groups. Postoperative serum calcium had no difference between the two groups (t=0.491, P=0.636). Serum PTH level after operation for 6 months was statistical different between the two groups (t=2.412, P=0.023). The recurrence rate was 27.3% in sPTx group and was 9.92% in tPTx+AT group (χ2=6.110, P=0.013). Conclusion Both tPTx+AT and sPTx have a significant short-term effect on SHPT. tPTx+AT is more conducive to reduce PTH and lower recurrence rate than sPTx. Severe complications are rare, but recurrence of SHPT is still present in some cases.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Autotransplantation, Parathyroid hormone

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