中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (03): 163-167.doi: 10.3969/j.issn.1671-4091.2015.03.00

• 临床研究 • 上一篇    下一篇

甲状旁腺全切+前臂移植术后复发性及持续性甲状旁腺功能亢进的治疗观察

王凯,刘章锁,王沛,武静   

  1. 郑州大学第一附属医院血液净化中心
  • 收稿日期:2014-09-04 修回日期:2014-11-13 出版日期:2015-03-12 发布日期:2015-04-20
  • 通讯作者: 刘章锁 wangkaitiger@126.com E-mail:zhangsuoliu666@126.com

Treatment of recurrent and persistent hyperparathyroidism after total parathyroidectomy and forearm autotransplantation: report of 16 cases from a single center

  • Received:2014-09-04 Revised:2014-11-13 Online:2015-03-12 Published:2015-04-20
  • Contact: zhang suoliu E-mail:zhangsuoliu666@126.com

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摘要： 【摘要】目的 回顾总结再次手术、传统药物治疗与新型维生素D类似物及磷结合剂3种方案对甲状旁腺全切+前臂移植(total PTX+forearm autotransplantation，tPTX+AT)术后复发性及持续性甲状旁腺功能亢进的治疗效果。 方法 调查我院2013年5月至2014年5月16例尿毒症患者行tPTX+AT术后出现复发性(13例)及持续性(3例)甲状旁腺功能亢进的治疗情况，治疗方案包括再次手术切除颈部残留的甲状旁腺或前臂移植物5例(方案i)、传统内科药物治疗6例(方案ii)、新型维生素D类似物及磷结合剂治疗5例(方案iii)，对三种治疗方案进行评价。 结果 3组患者在治疗后iPTH均有明显下降(P＜0.05)，ii组下降速度与幅度低于iii组患者(P＜0.05)，i组2名前臂移植物复发的患者因“前臂甲状旁腺移植物切除”失败在术后iPTH无明显变化；i组患者手术后血钙较手术前明显下降(P＜0.05)，手术后2周血磷水平下降明显(P＜0.05)，后逐渐上升，至34周血磷与手术前比较无明显变化(P＞0.05)，ii组患者治疗前后血钙、血磷上升明显(P＜0.05)，iii组患者治疗后血钙轻度升高，但是仍处于正常范围内，与治疗前相比较差异无统计学意义(P＞0.05)；血磷较治疗前明显下降(P＜0.05)；iii组患者在生理功能、躯体疼痛、情感职能、精神健康4个维度分值明显高于i组和ii组患者(均P＜0.05)。 结论 方案iii在降低iPTH水平、减少高钙血症与高磷血症风险、改善患者生活质量等方面可能优于方案i与ii。

关键词: 甲状旁腺功能亢进症, 甲状旁腺切除术, 复发, 尿毒症, 维生素D

Abstract: 【Abstract】 Objective To review the efficacy of re-operation, traditional medication therapy, and new vitamin D (VD) analogue combined with phosphate binder on the recurrent and persistent hyperparathyroidism after total parathyroidectomy and forearm autotransplantation (tPTX+AT). Methods The uremic patients with recurrent (13 cases) and persistent (3 cases) hyperparathyroidism after tPTX+AT from May 2013 to May 2014 in our hospital were analyzed. The treatment of these patients included re-operation to excise residual parathyroid gland in neck or forearm autotransplanted gland (group A, 5 cases), traditional medication therapy (group B, 6 cases), and new VD analogue combined with phosphate binder (group C, 5 cases). The effects of the three therapies were compared. Results Serum iPTH decreased significantly in all of the three groups after the treatment (P＜0.05) with the decrease rate and amplitude greater in group C than in group B (P＜0.05); iPTH was unchanged in the 2 cases in group A because of the failure of re-operation. In group A, serum calcium decreased significantly after re-operation (P0.05). In group B, serum calcium and phosphate increased significantly after routine medication therapy (P<0.05). In group C after new VD analogue + phosphate binder therapy, serum calcium increased slightly but was still in the normal range, and changed insignificantly as compared to the level before the therapy (P<0.05); serum phosphate decreased (P<0.05); the four-dimension scores of physiological functions, physical pain, emotional function, and mental health were significantly higher than those in groups A and B (P<0.05). Conclusion The therapy for group C (new VD analogue + phosphate binder) was better than the therapies for group A (re-operation) and B (routine medication) in lowering iPTH, reducing the risks for hypercalcemia and hyperphosphatemia, and improving quality of life in patients with recurrent and persistent hyperparathyroidism after tPTX+AT.

Key words: hyperparathyroidism, parathyroidectomy (PTX), recurrence, uremia, VD (Vitamin D)