超声引导下微创治疗严重继发性甲状旁腺功能亢进症  

Ultrasound guided minimally invasive treatment for patients with severe secondary hyperparathyroidism

作　　者：程晨[1] 张丽娜[1] 王宁宁[1] 范伯强[2] 

机构地区：[1]南京医科大学第一附属医院肾内科,南京210029 [2]南京医科大学第一附属医院肿瘤科,南京210029

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2016年第4期428-433,共6页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金(81270408;81570666);中华医学会临床科研专项基金首届肾脏病青年研究基金(13030300415);江苏省"医学重点人才"(RC201162);江苏省"六大人才高峰"资助课题[2010(IB10)];江苏省肾脏病临床研究中心专项BL2014080);江苏省2015年度普通高校研究生实践创新计划项目(SJZZ15-0116)

摘　　要：继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)是终末期肾脏病患者(endstage renal disease,ESRD)常见的并发症,表现为钙磷代谢紊乱、血清全段甲状旁腺素(intact parathyroid hormone,i PTH)分泌增多和甲状旁腺过度增生,可伴有心肺功能明显异常等,严重影响患者的生存质量及预后。目前药物不能控制的SHPT首选甲状旁腺切除术(parathyroidectomy,PTX)。随着医疗新技术的发展,超声引导下甲状旁腺微创操作(主要包括药物注射及热消融)逐渐成为SHPT的重要辅助治疗手段,其在局部麻醉下完成,创伤相对小,可以应用于因严重心肺功能不全等原因不能耐受或不愿行全身麻醉下外科手术的患者,但如何客观地评估其安全性和有效性、减少不良反应和严重并发症依然是临床值得关注的问题,该类技术的广泛应用和推广还有待多学科深入合作、不断改进操作细节,以及更多大样本、长期随访病例的报道和经验总结。本文对目前超声引导下微创治疗SHPT的方法、适应证及其疗效做一综述。Secondary hyperparathyroidism （SHPT） is a common complication of end-stage renal disease （ESRD） which affects life quality and prognosis of patients. The clinical manifestations of SHPT include calcium and phosphorus metabolism disorder, increased serum intact parathyroid hormone （iPTH）, hyperplasia of parathyroid glands, and even serious dysfunction of heart and pulmonary. Parathyroidectomy （PTX） is preferred in severe SHPT pa- tients who are resistant to pharmacological therapies. With the development of novel medical technology, ultrasound guided minimal invasive operations （mainly include drug injection and thermal ablation） have gradually become an impor- tant adjuvant therapy of SHPT. These methods can be performed under local anesthesia with relatively minor trauma espe- cially suitable for patients with severe cardiopulmonary insufficiency who couldn＇t tolerate surgery under general anesthesia or patients who reject surgery. However, it remains to be concern in clinic to evaluate the efficacy and security, and meanwhile to reduce the risk of adverse effects and severe complications. Wide use of this technology still need multi-dis- ciplinary in-depth cooperation, and constant improvement of the operational details, and more large sample and long-term follow-up reports of cases and experience summary. In this review, we summarize the methods, indications and effects of differen.t ultrasound guided minimal invasive treatments for SHPT patients.

关 键 词：继发性甲状旁腺功能亢进 微创治疗 热消融 射频消融 微波消融 

分 类 号：R582[医药卫生—内分泌]