手术治疗透析患者继发性甲状旁腺功能亢进症的临床疗效——附45例分析  

Clinical efficacy of parathyroidectomy in treating secondary hyperparathyroidism in dialysis patients: a analysis of 45 cases

作　　者：梁伟[1] 李朋[2] 陈丽[1] 邹莎琳[1] 姜蕾[1] 

机构地区：[1]北京大学深圳医院肾内科,深圳518036 [2]北京大学深圳医院甲状腺外科,深圳518036

出　　处：《新医学》2017年第2期128-131,共4页Journal of New Medicine

摘　　要：目的探讨甲状旁腺切除术对维持性透析患者继发性甲状旁腺功能亢进症的临床疗效和并发症发生情况。方法收集45例维持性透析继发性甲状旁腺功能亢进症患者,比较手术前后钙磷、全段甲状旁腺激素、碱性磷酸酶和症状等变化,分析手术并发症、甲状旁腺功能亢进复发及预后等情况。结果 45例患者中,行甲状旁腺全切加前臂自体移植术39例,甲状旁腺次全切术6例。其中42例患者切除4枚甲状旁腺,1例切除5枚甲状旁腺,2例切除3枚甲状旁腺;45例均有结节性增生,5例合并甲状旁腺腺瘤。术后45例患者的血磷、甲状旁腺激素及碱性磷酸酶均比术前下降(P均<0.0125)。术后1周内发生低钙血症37例(82%),需静脉补钙超过1周者34例,超过2周9例,仅1例超过1个月,3例未行静脉补钙治疗;术中2例(4%)发生喉返神经损伤,术后1周内骨折3例(7%),均为下肢骨折,2例恢复、1例愈合不良;切口血肿2例(4%)。术后无出现大血肿、窒息或死亡病例。44例患者骨痛、关节痛及皮肤瘙痒等症状多于术后1个月内缓解,仅1例患者的骨痛在术后1年才缓解。2例(4%)甲状旁腺功能亢进复发。结论甲状旁腺切除术是治疗维持性透析继发性甲状旁腺功能亢进症的有效方法,但需重视对其术后并发症的防治。Objective To evaluate the clinical efficacy and postoperative complications of parathyroidectomy in the treatment of secondary hyperparathyroidism in patients receiving maintenance dialysis. Methods Clinical data of 45 patients diagnosed with secondary hyperparathyroidism receiving maintenance dialysis were retrospectively analyzed. The changes in calcium,phosphorus,total parathormone,alkaline phosphatase and clinical symptoms were observed before and after parathyroidectomy. Surgical complications,recurrence of hyperparathyroidism and clinical prognosis were analyzed. Results Among 45 patients,39 underwent total parathyroidectomy combined with forearm auto-transplantation,and 6 received subtotal parathyroidectomy. Four parathyroid glands were resected in 42 patients,5 in 1 case and 3 in 2 patients. Nodular hyperplasia was observed in 45 cases. Five patients were complicated with parathyroid adenoma. After surgery,the levels of phosphorus,parathormone and alkaline phosphatase in 45 patients were significantly declined（ all P〈0. 0125）.Within 1 week after surgery,hypocalcemia was observed in 37 cases（ 82%）. Intravenous administration of calcium was delivered for over 1 week in 34 cases,over 2 weeks in 9 patients and more than 1 month in 1 case.Intravenous administration of calcium was not given in 3 patients. Intraoperatively,2 cases（ 4%） presented with recurrent nerve injury. Within postoperative 1 week,3 patients（ 7%） suffered from lower limb fracture,2 of them were recovered and 1 achieved poor healing. Two patients（ 4%） had incisional hematoma. Postoperative massive hematoma,apnea or death was not documented. Bone pain,joint pain and cutaneous pruritus in44 patients were alleviated within postoperative 1 month. The bone pain in 1 case was mitigated at postoperative1 year. Two patients（ 4%） presented with recurrent hyperparathyroidism. Conclusions Parathyroidectomy is an efficacious treatment of secondary hyperparathyroidism following maintenance dialysis. However,much attention should

关 键 词：维持性透析 继发性甲状旁腺功能亢进症 甲状旁腺切除术 

分 类 号：R653[医药卫生—外科学] R692.5[医药卫生—临床医学]