甲状旁腺切除术治疗尿毒症继发性甲状旁腺功能亢进30例  

Analysis on effect of parathyroidectomy for uremia complicated with secondary hyperparathyroidism of 30 cases

作　　者：李峰[1] 张明[1] 高鑫[1] 

机构地区：[1]解放军88医院肾内科,山东泰安271000

出　　处：《实用医药杂志》2016年第7期593-596,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨甲状旁腺切除术(parathyroidectomy,PTX)治疗尿毒症继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的临床效果。方法对30例尿毒症维持性血液透析SHPT患者行甲状旁腺切除术的临床资料进行回顾性分析。对比患者术前、术后及随访6个月时血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)和血清钙、血磷和血碱性磷酸酶检测结果及临床表现等。结果 30例患者中,20例行甲状旁腺次全切除术(subtotal parathyroidectomy,SPTX),8例行甲状旁腺全切除术(total PTX,TPTX),2例行甲状旁腺全切+自体移植术(TPTX+autotransplatation,TPTX+AT)。所有患者甲状旁腺病理上均有结节增生(100%),有的伴钙化、出血或囊变。手术后4例患者出现一过性声音嘶哑,无吞咽困难、饮水呛咳、窒息等。24例患者出现明显低钙血症(血清钙<1.8 mmol/L),均经静脉及口服补钙后好转,静脉补钙时间最长18 d,最短3 d。在30例患者中,2例骨痛无明显缓解,iPTH在1个月后升至500 Pg/ml;1例死于心肌梗死;其余27例肌无力、骨痛及皮肤瘙痒症状明显缓解,失眠和纳差症状迅速改善,贫血及全身营养状况好转,与术前比较,术后血iPTH、血钙、血磷及钙磷乘积水平均显著降低(P<0.05)。手术有效率90.0%(27/30)。结论对于尿毒症SHPT患者行PTX是一种安全、有效的治疗方式,术后患者甲状旁腺激素及血磷水平明显降低,可以明显改善患者生活质量,延长透析患者的存活时间。Objective To explore the therapeutic effect of parathyroidectomy（PTX） on uremia complicated with secondary hyperparathyroidism （SHPT）. Methods Authors retrospectively analyzed the clinical data of 30 uremia patients complicated with secondary hyperparathyroidism （SHPT） surgically treated with parathyroidectomy （PTX）. Serum intact parathyroid hormone （iPTH）,calcium （Ca）,phosphorus （P）,alkaline phosphatase （ALP） and clinical symptoms obtained at preoperation,postoperation and within follow-up of 6 months were collected and compared. Results Subtotal PTX operation was performed successfully on 20 patients,TPTX operation on 8 patients,and TPTX＋AT operation on 2 patients. All parathyroid pathologically showed nodular hyperplasia （100%）, and some with calcification,hemorrhage and cystic degeneration. After operation,4 cases had early operative complication of transient hoarseness,but without dysphagia and asphyxia;24 cases had the complication of hypocalcemia （Serum Ca〈l.8 mmol/L）,and all these patients got improved by oral or intravenous calcium supplement. The administration time of intravenous calcium supplement differed from 3 to 18 days. Among the 30 cases after operation,bone pain was not improved in 2 cases,and their serum iPTH levels went up over 500 pg/ ml;1 patient died of myocardial infarction. In the other 27 cases,myasthenia,bone pain,itch of skin,insomnia, anorexia,animia and nutritional status were markedly improved,and serum iPTH,Ca,P,and the product of Ca and P decreased significantly after PTX compared with those before PTX （P〈0.05）. The surgical effective rate was 90.0%（27/30）. Conclusion SHPT PTX is a safe and effective surgery for the patients with uremia. Parathyroid hormone and blood phosphorus levels in postoperative patients significantly decreased. SHPT PTX can significantly improve patient＇s quality of life,and prolong the survival time. of dialysis patients.

关 键 词：尿毒症 继发性甲状旁腺功能亢进 甲状旁腺切除术 

分 类 号：R582[医药卫生—内分泌]