72例继发性甲状旁腺功能亢进行甲状旁腺次全切除术的治疗分析  

Therapeutic effect of subtotal parathyroidectomy for 72 uremic patients with secondary hyperparathyroidism

作　　者：高恒元[1] 许楠[1] 罗勋鹏[1] 刘新杰[1] 周冬仙[1] 麦沛成[1] 张桂英[1] 

机构地区：[1]暨南大学附属第二医院(深圳市人民医院)甲状腺外科,广东深圳518020

出　　处：《中国现代普通外科进展》2017年第9期684-686,691,共4页Chinese Journal of Current Advances in General Surgery

基　　金：深圳市卫生计生系统科研项目(201402008)

摘　　要：目的:探讨甲状旁腺次全切术治疗继发性甲状旁腺功能亢进的疗效。方法:回顾性分析2010年1月—2014年12月收治的72例继发性甲状旁腺功能亢进行甲状旁腺次全切术患者的临床资料,分析术前、术中及术后1 d、1周、6个月的甲状旁腺激素(PTH)和血钙、血磷水平,比较患者手术前后瘙痒、骨痛等症状的改善及生活质量、肾性高血压等变化情况。结果:(1)72患者手术成功70例,成功率为97.2%。(2)术后临床症状改善情况:大部分患者全身瘙痒症状得到明显缓解,关节疼痛症状逐渐消失,生活质量迅速改善;部分患者肾性高血压较术前缓解;13例靠轮椅代步的患者出院时均能行走。(3)术后1 d、1周、1月、6月复查血PTH、磷水平均较术前明显下降(P<0.05)。(4)术后发生低钙血症53例,发生率73.6%,均经口服及静脉补钙后得到缓解。(5)术后随访至少6个月,66例患者病情稳定,血PTH、钙及磷水平维持在正常范围,部分患者血钙稍低于正常范围,但无低血钙症状;4例患者复发,复发率为5.7%。结论:甲状旁腺次全切术是治疗继发性甲状旁腺功能亢进安全有效的方法。Objective： To retrospectively analyze the therapeutic effect of subtotal parathy-roidectomy （sT-PTX） on uremic patients with secondary hyperparathyroidism （SHPT）. Methods： Seventy two SHPT patients treated with sT-PTX in our hospital were enrolled in this study. Serum parathyroid hormone（PTH）, calcium（Ca） and phosphorus（P） obtained in the preoperative, postopera- tive and followup periods were collected and compared, Their symptoms, postoperative complica- tions and relapse were recorded. Results： （1）sT-PTX operation performed successfully in 70/72 patients（97.2%）. （2）After sT-PTX, bone pain and itching improved rapidly, with the improvement of nutritional status, Partial patients with renal hypertension were remitted compared with preoperative. Thirteen cases can walk without wheelchair after sT-PTX. （3）Serum PTH, Ca, and P decreased sig- nificantly after sT-PTX for one week, one month and 6 months as compared with those before sT-PTX（P〈0.05）. （4）Postoperative hypocalcemia was frequently seen（53/72, 53.6%） but could be ef- fectively controlled by intravenous calcium infusion. （5）SHPT recurred in the 6 months after sT-PTX in 4 cases （5.7%）. Conclusions： T-PTX can effectively decrease PTH level and improve symp- toms, and is a safe measure for the treatment of uremic patients with SHPT.

关 键 词：继发性甲状旁腺功能亢进 甲状旁腺次全切术 甲状旁腺激素 肾功能不全 

分 类 号：R653[医药卫生—外科学]