超声引导下微波消融术治疗继发性甲状旁腺功能亢进的临床观察  

The efficiency of ultrasound guided microwave ablation therapy for secondary hyperparathyroidism

作　　者：廖琪[1] 刘金伟 黄江燕[1] 胡广[1] 邹贵勉[1] 眭维国[1] 

机构地区：[1]解放军第一八一医院肾脏科全军器官移植与透析治疗中心,广西代谢性疾病研究重点实验室,桂林541002 [2]解放军第一八一医院超声科,桂林541002

出　　处：《中国血液净化》2017年第11期741-745,共5页Chinese Journal of Blood Purification

摘　　要：目的探讨超声引导下微波消融术(microwave ablation,MWA)治疗尿毒症继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的临床疗效和安全性。方法选择18例尿毒症SHPT的血液透析患者,在超声引导下进行甲状旁腺微波消融术。观察患者术前、术后2小时、1天、1周、1月、6月和1年的甲状旁腺激素(parathyroid hormone,PTH)、血钙、血磷、碱性磷酸酶(alkaline phosphatase,ALP)水平的变化。同时观察临床症状的改善、并发症的发生情况。结果 18例患者共消融甲状旁腺56枚,术后2h、1d、1周、1月、6月和1年PTH水平分别为(460.47±473.79)ng/L、(448.92±306.36)ng/L、(354.69±325.87)ng/L、(275.60±232.95)ng/L、(304.60±277.67)ng/L、(293.76±277.68ng/L)较术前(1593.72±567.40)ng/L明显下降,差异有统计学意义(t=6.504,P<0.001;t=5.849,P<0.001;t=7.976,P<0.001;t=5.745,P<0.001;t=4.757,P<0.001;t=3.467,P=0.002),术后2小时至术后1年PTH差异无统计学意义(F=0.194,P=0.964);10例患者发生低钙血症(55.56%),经积极补钙后能维持血钙在(1.96±0.16)mmol/L。3例出现内瘘闭塞(16.67%),3例患者出现一过性喉返神经损伤(16.67%)。结论超声引导下微波消融术是一种治疗SHPT安全、有效的方法。Objective To explore the safety and efficacy of microwave ablation （MWA） in uremic pa-tients with secondary hyperparathyroidism （SHPT）. Methods Eighteen patients with end-stage renal disease and SHPT received microwave ablation guided by color Doppler ultrasound. Laboratory tests including serum parathyroid hormone （PTH）, calcium, phosphorus and alkaline phosphatase （ALP） were conducted before the therapy and after the therapy for 2 hours, one day, one week, one month, 6 months and one year. Improvement of SHPT-related symptoms after ablation and complications during and after MWA were recorded. Results Fifty-six hyperparathyroidism nodules in 18 patients were treated by MWA. In patients treated with MWA, se-rum PTH was 460.47＆#177;473.79 ng/L after 2 hours, 448.92＆#177;306.36 ng/L after one day, 354.69＆#177;325.87 ng/L after one week, 275.60＆#177;232.95 ng/L after one month, 304.60＆#177;277.67 ng/L after 6 months and 293.76＆#177;277.68 ng/L after one year, significant different as compared with the value before treatment （1593.72 ＆#177; 567.40 ng/L; t=6.504, 5.849, 7.976, 5.745, 4.757 and 3.467, respectively;P〈0.001 for all the PTH values）. However, there was no significant difference between the PTH levels after MWA （F=0.194, P=0.9640）. After MWA, hypocal-caemia occurred in 10 patients （55.56%） and was rapidly corrected with calcium supplement, arteriovenous fistula occlusion was found in 3 patients （16.67%）, and transient hoarseness happened in 3 patients （16.67%）. Conclusion MWA is a safe and effective measure to manage SHPT.

关 键 词：继发性甲状旁腺功能亢进 超声 微波消融术 

分 类 号：R318.16[医药卫生—生物医学工程]