继发性甲状旁腺功能亢进症的外科治疗效果  

SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM

作　　者：陈超[1] 尹乐平[1] 冯超[1] 顾毅[1] 刘彤[1] 

机构地区：[1]四川省医学科学院四川省人民医院普外科,四川成都610072

出　　处：《齐鲁医学杂志》2017年第1期95-97,共3页Medical Journal of Qilu

摘　　要：目的探讨外科手术治疗继发性甲状旁腺功能亢进症(SHPT)的临床效果。方法 SHPT病人72例,均行甲状旁腺全切加前臂移植术,分别于术前、术后1d、术后7d和术后6个月检测病人血甲状旁腺激素(iPTH)水平和血钙、血磷水平,比较病人手术前后骨痛、皮肤瘙痒和乏力症状改善情况。结果 72例病人手术均顺利完成,切除甲状旁腺3枚者5例,4枚者65例,5枚者1例,6枚者1例。切除的甲状旁腺术后病理检查结果均为甲状旁腺增生或腺瘤样增生。SHPT病人术前iPTH平均值为(2 153.68±342.17)ng/L,与术前相比,术后1d、7d、6个月显著下降,差异有统计学意义(F=830.008,P<0.05);术后1、7d血钙水平降低,术后6个月血钙水平小幅度回升,差异均有显著性(F=259.811,P<0.05)。与术前相比,术后1d、7d、6个月血磷水平显著降低,差异均有统计学意义(F=85.540,P<0.05)。术后病人骨痛、皮肤瘙痒、乏力症状得到明显改善。结论外科手术治疗SHPT效果确切,安全可靠,可显著改善病人生活质量。Objective To assess the clinical effectiveness of surgery in the treatment of secondary hyperparathyroidism（SHPT）. Methods Seventy-two patients with SHPT underwent total parathyroidectomy plus forearm grafting.The levels of blood parathyroid hormone（iPTH）,calcium and phosphorus-before surgery,one and seven days after surgery,as well as six months after surgery-were measured.The symptoms of bone pain,itch of skin and fatigue,before and after surgery,were compared. Results Operations were successfully completed in all the 72 patients.The number of resected parathyroid glands in each patient was as follows：three glands were removed in five cases,four glands in 65,five glands in one case,and six glands in one case.Pathological findings were parathyroid hyperplasia or adenomatous hyperplasia.The mean preoperative iPTH of the 72 patients was（2 153.68 ±342.17）ng/L,that was markedly declined-one day,seven days and six months after surgery,the difference being statistically significant（F=830.008,P〈0.05）.The serum calcium level declined one and seven days after surgery,and it rebounded slightly six months after surgery,the difference was significant（F=259.811,P〈0.05）.Compared with before surgery,blood phosphorus level was significantly lower-one day,seven days and six months after surgery（F=85.540,P〈0.05）.The symptoms of bone pain,itch of skin and fatigue improved significantly after surgery. Conclusion Surgical therapy of secondary hyperparathyroidism is effective,safe and reliable,which can significantly improve the quality of life of the patients.

关 键 词：甲状旁腺功能亢进症 继发性 甲状旁腺切除术 重复测量方差分析 

分 类 号：R582.1[医药卫生—内分泌]