无自体移植的甲状旁腺全切除术在难治性继发性甲状旁腺功能亢进中的应用  

Application of total parathyroidectomy without autotransplantation in refractory secondary hyperparathyroidism

作　　者：杨猛[1] 张凌[2] 黄林平[1] 孙小亮[1] 刘军[1] 纪浩洋[1] 鲁瑶[1] 

机构地区：[1]中日友好医院乳腺甲状腺外科,北京100029 [2]中日友好医院肾病中心,北京100029

出　　处：《中国现代普通外科进展》2017年第5期342-345,共4页Chinese Journal of Current Advances in General Surgery

基　　金：中日友好医院青年科技英才计划(2014-QNYC-A-08);北京市科委首都特色医学基金(Z151100004015112;Z151100004015244)

摘　　要：目的:分析继发性甲状旁腺功能亢进症(SHPT)患者行无自体移植的甲状旁腺全切除术(TPTX)的临床效果和可行性。方法:回顾性分析2012年4月—2015年12月中日友好医院乳腺甲状腺外科行TPTX治疗的220例SHPT患者的临床资料,观察其疗效及并发症。结果:220例均为长期透析患者,透析时间为(7.93±3.75)年,术前甲状旁腺激素(PTH)、钙、磷明显升高,术后明显降低,分别为(73.65±181.46)pg/mL、(1.82±0.31)mmol/L、(1.51±0.59)mmol/L(P<0.01),平均住院日(7.8±2.8)d,症状缓解明显,无喉返神经损伤、大出血等严重并发症出现,低钙血症发生率为73.64%,经积极加强补钙后都可缓解,无低动力性骨病出现,20例术后呈甲状旁腺功能亢进持续状态(PTH≥300pg/mL),占9.1%,围手术期1例因感染性休克死亡,占0.45%。结论:TPTX治疗SHPT临床疗效安全可靠,手术方式易于统一规范,值得推广应用,减少术中甲状旁腺遗漏是手术成功的关键,加强监测和保持血钙稳定是减少术后并发症的关键。Objective： To analyze the clinical outcome and feasibility for patients who under- went total parathyroidectomy without autotransplantation （TPTX） for secondary hyperparathyroidism （SHPT）. Methods： From April 2012 to December 2015, 220 SHPT patients underwent TPTX in the department of Breast and Thyroid Surgery of China-Japan Friendship Hospital. The clinical data and effect were assessed retrospectively. Results： All the 220 patients were on permanent dialysis with mean duration of dialysis （7.93 ± 3.75） years. A durable reduction in mean PTH, Ca and P were observed after TPTX （P〈0.01）. The mean hospital stay was （7,8 ± 2.8） days; TPTX produced a rapid improvement in clinical symptoms. Incidence of hypocalcemia was 73.46%. Severe complications such as recurrent laryngeal nerve palsy or inactive dynamic osteopathia, haven＇t been observed postoperatively. The rate of persistent status （PTH≥ 300 pg/mL） was 9.1%. One （0.45%） died of in- fectious shock perioperatively. Conclusions： TPTX was a safe and feasible surgical procedure for patients with SHPT. It was worth of being applied. Not missing the parathyroid during operation was the key point for successful TPTX. Intensive monitoring and maintaining stable normocalcemia were the key point to reduce complication.

关 键 词：继发性甲状旁腺功能亢进 甲状旁腺全部切除术 

分 类 号：R653[医药卫生—外科学]