肾性甲状旁腺功能亢进症甲状旁腺全切加前臂移植31例临床分析  

Efficiency of total parathyroidectomy and autotransplantation in 31 patients with uremic hyperparathyroidism

作　　者：胡建明[1] 吴宏飞[2] 王笑云[1] 俞香宝[1] 赵奕华[1] 沈霞[1] 刘佳[1] 孙彬[1] 邢昌赢[1] 杨俊伟[1] 

机构地区：[1]南京医科大学第一临床医学院肾科,210029 [2]南京医科大学第一临床医学院泌尿外科,210029

出　　处：《中华内科杂志》2006年第9期714-716,共3页Chinese Journal of Internal Medicine

基　　金：江苏省135重点学科基金资助(135-13)

摘　　要：目的总结31例尿毒症继发性甲状旁腺功能亢进症(以下简称甲旁亢)行甲状旁腺全切加前臂移植的临床经验。方法回顾性分析1996-2005年我院肾科行甲状旁腺全切加前臂移植者31例的临床特点、相关内科处理及疗效。结果 31例患者为长期血液透析者(平均透析9.2年),26例有骨痛,11例有骨折,25例有皮肤瘙痒,14例有转移性钙化。(2)31例患者血甲状旁腺激素(iPTH)平均为(1811±879)ng/L;颈部 B 超及发射型计算机体层摄影术均证实有增生肿大的甲状旁腺2～4枚,内科治疗均失败。(3)31例患者均做甲状旁腺全切加前臂移植术,术后症状明显改善。iPTH 快速下降至200 ng/L 以下。高钙、高磷恢复至正常水平,碱性磷酸酶逐步下降。随访最长时间9年,目前 iPTH、钙、磷正常。结论严重肾性甲旁亢对内科治疗失败者应及时行甲状旁腺全切加前臂移植治疗,疗效可靠。Objective To analyse the efficacy of total parathyroidectomy with autotransplantation （total PTX ＋ AT ） in treating uremic secondary hyperparathyroidism and to discuss the relevant medical treatment used. Methods The clinical data of 31 patients with uremic SHPT admitted into our hospital from 1996 - 2005 were analysed with respect to total PTX ＋ AT. Results The period of hemodialysis were for the patients was on the average 9.2 years. There were 22 male and 9 female with an average age of 42.4 （31 -67） years . The clinical manifestations consisted of osteoarticular pain in 83.9% , fractures in 35.5% , soft tissue and vascular calcification in 45.2% and pruritus in 80.6%. Laboratory examination yielded the following results： haematocrit 0.25 ±0.04, serum Ca （2.61±0.35） mmol/L, serum P （2. 14 ± 0.31 ） mmol/L, plasma total alkaline phosphatase （ AKP ） （ 885 ±335 ） U/L and parathyroid hormone （ iPTH ） （1811 ± 879 ）ng/L （700 - 2500 ng/L）. Ccervical ultrasonography and/or emission computed tomography showed 2 - 4 hyperplastic glands. All of the patients showed no response to medical treatment including vitamin D. Total ＋ AT was performed on the 31 eases. Clincal symptoms and signs markedly improved after operation in 1 to 2 weeks. However, fracture and ectopic calcification showed no improvent. Plasma iPTH decreased rapidly（ 〈200 ng/L） postoperatively in 1 to 2 days. Serum Ca and P retured to nomal. AKP was corrected in 1 to 3 months. Conclusion Total parathyroideetomy with autotransplantation is an effective treatment for severe uremic secondary hyperparathyroidism patients.

关 键 词：尿毒症 甲状旁腺功能亢进症 继发性 甲状旁腺全切加前臂移植 

分 类 号：R653[医药卫生—外科学]