甲状旁腺全切除加前臂移植术治疗尿毒症继发性甲状旁腺功能亢进症  

Total parathyroidectomy with forearm autograft in the treatment of uremic patients with secondary hyperparathyroidism

作　　者：葛益飞[1] 任海滨[1] 刘佳[1] 俞香宝[1] 孙彬[1] 毛慧娟[1] 张波[1] 王宁宁[1] 朱亚梅[1] 查小明[2] 孙跃明[2] 邢昌赢[1] 

机构地区：[1]南京医科大学第一附属医院肾内科,210029 [2]南京医科大学第一附属医院普通外科,210029

出　　处：《中华肾脏病杂志》2013年第1期16-20,共5页Chinese Journal of Nephrology

摘　　要：目的回顾性分析甲状旁腺全切除（PTX）加自体前臂移植术治疗尿毒症继发性甲状旁腺功能亢进症（SHPT）的疗效和安全性。方法回顾性分析2001—2010年在本院行PTX加自体前臂移植术的118例终末期肾病尿毒症患者临床资料。收集患者术前、术后以及随访的血全段甲状旁腺素（iPTH）和生化（血清钙、磷和碱性磷酸酶）结果。记录患者临床症状、术后症状缓解情况、术后并发症和复发情况。结果118例患者中32例行微创手术，86例行普通开放手术。总手术成功率为93．2％（110／118）。2例患者在术中发现甲状腺癌而行根治术。术后围手术期死亡1例。9例发生喉返神经一过性损伤，发生率为7．6％。术后低钙血症发生率91．5％（108／118），经积极静脉或口服补钙后均获有效控制。手术成功患者的骨痛及瘙痒症状全部缓解，贫血、全身营养状况好转。与术前比较，患者术后血iPTH、血磷、血钙及钙磷乘积水平降低，差异均有统计学意义（均P〈0．01）。随访3年以上患者21例，6例SHPT复发，其中4例切除前臂移植的甲状旁腺后好转，2例接受再次手术后好转。最长随访9年的2例，均未复发。结论PTX加自体前臂移植术是治疗尿毒症SHPT的一种安全有效的手段，长期随访无严重并发症发生。Objective To analyze the efficacy and safety of total parathyroidectomy （PTX） with forearm autografl in uremic patients with secondary hyperparathyroidism （SHPT）. Methods One hundred and eighteen cases undergoing PTX with forearm autograft in our hospital from 2001- 2010 were included in this study. Their preoperative and postoperative serum intact parathyroid hormone （iPTH）, biochemistry tests （total calcium, inorganic phosphate and alkaline phosphate） were collected and postoperative symptom relief, complications and recurrence were investigated. Results Of all the 118 cases, 32 underwent endoscopic surgery and 86 open surgery. The surgery was performed successfully in 110 cases （93.2%） and one case died in perioperative period. Thyroid carcinoma was diagnosed during surgery in 2 cases and radical operation was performed at the same time. Temporary injury of recurrent laryngeal nerve was found in nine cases （7.6%）. Postoperativehypocalcemia was frequently seen in 108 cases （91.5%） and it was effectively controlled by postoperative calcium administration. After operation, bone pain and itching were alleviated, and weakness, anemia and malnutrition status were improved in all the cases who received successful surgery. The postoperative levels of serum iPTH （P 〈 0.01）, calcium （P 〈 0.01）, phosphorus （P 〈 0.01） and calcium^phosphorus （P 〈 0.01） were decreased significantly than those in preoperative period. A long-term follow-up of over 3 years was carried out in 21 cases. Six cases recurred, among them, 4 cases relieved after removal of autografted parethroid tissue, and another two cases received the second operation. The longest follow- up period lasted for 9 years in two cases without recurrence. Conclusions PTX with forearm autograft is safe and effective in the treatment for uremic patients with SHPT. No severe complication is found during the long-term follow-up period.

关 键 词：尿毒症 甲状旁腺功能亢进症 继发性 甲状旁腺移植 前臂 甲状旁腺 切除 

分 类 号：R692.5[医药卫生—泌尿科学]