甲状旁腺全切术治疗继发性甲状旁腺功能亢进症35例  

Analysis of 35 cases of secondary hyperparathyroidism treated with total par-athyroidectomy

作　　者：许楠[1,2] 刘新杰[1,2] 周冬仙[1,2] 何文亮[1,2] 高恒元[1,2] 王元阳 

机构地区：[1]暨南大学附属第二医院 [2]深圳市人民医院甲状腺外科,广东深圳518020

出　　处：《暨南大学学报（自然科学与医学版）》2014年第2期182-185,共4页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：深圳市科技计划项目(201002023)

摘　　要：目的:甲状旁腺全切术治疗继发性甲状旁腺功能亢进症的疗效与安全性等问题上存在争议,需要进一步探讨.方法:继发性甲状旁腺功能亢进症患者35名,均行甲状旁腺全切术,分别于术前、术中、术后1 d、1周和6个月检测患者的全段甲状旁腺激素(intact parathyroid hormone,iPTH)和血钙、血磷水平,比较患者手术前后瘙痒、骨痛等症状及生质量等方面改变,观察术后并发症,了解继发性甲旁亢的复发情况.结果:35例患者(100%)甲状旁腺病理上均有结节性增生,部分合并弥漫性增生.在35例患者中共发现138枚甲状旁腺,其中有2例(5.7%)仅有3枚甲状旁腺.术前iPTH(2 152.59±937.88)pg/mL,术后7 d iPTH(14.11±14.42)pg/mL,iPTH显著性降低(P<0.05);术后7 d血钙水平为(1.61±0.32)mmol/L,多数患者存在手足麻木症状,但经过静脉及口服补钙治疗,低血钙症状可以控制,患者能够良好耐受,均未发生严重低血钙事件.术后患者骨痛、皮肤瘙痒等症状得到显著改善.术后随访至少6个月,无1例复发.结论:甲状旁腺全切术是治疗继发性甲状旁腺功能亢进症疗效满意且安全可靠的手术方式.Aim：To investigate the efficacy and safety of total par-athyroidectomy （tPTX）in the treat-ment of secondary hyperparathyroidism（SHPT）.Methods：Thirty-five SHPT patients treated with tPTX cases were reviewed retrospectively.Their average age was （46.8 ±8.6 ）years old,and their dialysis age ranged （79.6 ±52.3）months.Biochemical parameters、iPTH and symptoms before and after opera-tion,operation complications and recurrence of SHPT were analyzed.Results：All parathyroid samples showed nodular changes on pathological examination,some samples also accompanied with diffuse prolifer-ation.138 parathyroid glands have been found in 35 cases.Only 3 parathyroid glands were found in 2 pa-tients （5.7%）.The mean iPTH was （2 152.59 ±937.88）pg/mL before operation and was （14.1 1 ± 14.42）pg/mL on the 7th day after operation,the difference is significant（P＆lt;0.05）.The mean blood calcium concentration was （1.61 ±0.32）mmol/L on the 7th day after operation.The most prevalent postoperation complication was hypocalcemia.All patients required oral or intravenous calcium supple-ment.No Severe hypocalcemia event was observed.Bone pain and pruritus re-lieved significantly after operation.6 months of follow-up were given,no recurrence was observed.Conclusion：tPTX is a rela-tively safe and effective method in the treatment of patients with SHPT.

关 键 词：继发性甲状旁腺功能亢进症 甲状旁腺全切术 甲状旁腺激素 

分 类 号：R653[医药卫生—外科学]