甲状旁腺全切加前臂移植术对甲状旁腺功能亢进患者血压的影响  

Effect of total parathyroidectomy with forearm autograft on blood pressure in uremic patients with secondary hyperparathyroidism

作　　者：徐涵[1] 袁亮[1] 王德光[1] 郝丽[1] 

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《肾脏病与透析肾移植杂志》2014年第2期136-139,共4页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：安徽省高等学校省级自然科学研究项目(KJ20132154)

摘　　要：目的:观察甲状旁腺全切加前臂移植术对肾性继发性甲状旁腺功能亢进(SHPT)患者血压的影响。方法:(1)选择2011年2月至2013年3月41例随访>3月的难治性肾性SHPT患者41例,其中35例合并高血压。观察手术前后血压、全段甲状旁腺激素(iPTH)、血钙、磷及相关临床症状的变化。结果:41例患者顺利完成手术,35例患者完整切除4枚甲状旁腺,5例患者术中仅发现并切除3枚甲状旁腺,1例患者发现并切除2枚甲状旁腺。手术成功的患者iPTH、钙、磷水平较术前明显下降(P<0.05),28例合并高血压的患者术后血压得到有效控制。结论:难治性肾性甲状旁腺亢进功能合并高血压的患者,接受甲状旁腺全切加前臂移植术可明显提高对血压的控制率,这对降低慢性肾脏病患者心脑血管并发症有重要意义。Objective ：To observe the effect of total parathyroidectomy with forearm autograft （PTX＋AT） on blood pressure in patients with secondary hyperparathyroidism （ SHPT ） of chronic kidney disease （ CKD ）. Methodology ： Between February 2011 and March 2013, in 41 cases of secondary hyperparathyroidism （SHPT） of chronic kidney （ CKD ） patients were treated with PTX＋AT, 35 cases with hypertension. The follow-up period was more than 3 months. The change of serum iPTH, blood pressure, calcium, and phosphorus were observed in the preoperative, postoperative and follow-up periods. Results： （ 1 ） 41 patients successfully underwent surgery, 35 patients had their 4 parathyroid glands removed, in 5 patients only 3 parathyroid glands were discovered and removed, and in 1 patient 2 parathyroid glands were found and removed. （2） Postoperative serum iPTH, calcium, phosphate, and the blood pressure decreased significantly compared with the preoperative. In 28 cases with hypertension, blood pressure was effectively controlled after surgery. Conclusion：In patients with secondary hyperparathyroidism and hypertension, total parathyroidectomy with forearm autograft can significantly improve hypertension control rates, which is meaningful for reducing cardiovascular complications in patients with CKD.

关 键 词：慢性肾脏病 继发性甲状旁腺功能亢进 甲状旁腺全切加前臂移植 高血压 

分 类 号：R653[医药卫生—外科学]