甲状旁腺全切术后一过性甲亢的发生情况及影响因素分析  

Occurrence and Related Factors of Transient Hyperthyroidism after Total Parathyroidectomy

作　　者：赵沙沙 熊明霞[1] 闻萍[1] 甘巍 曹金龙[1] 杨俊伟[1] ZHAO Sha-sha;XIONG Ming-xia;WEN Ping;GAN Wei;CAO Jin-long;YANG Jun-wei(The second affiliated hospital ofnanjing medical university,department of nephrology,Nanjing,Jiangsu,210000,China)

机构地区：[1]南京医科大学第二附属医院,江苏南京210000

出　　处：《现代生物医学进展》2019年第6期1064-1068,共5页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81530022)

摘　　要：目的:分析继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者行甲状旁腺切除术(parathyroidectomy,PTX)后一过性甲亢的发生情况及影响因素。方法:选自2018年5月因SHPT连续在我院行PTX的28例患者,手术前后定期复查患者的甲状腺功能,并记录患者手术前后心率及有无心慌不适等症状。结果:纳入患者术前的甲功均正常,术后TSH由术前平均值1.96±0.94μIU/m L降到术后第四天最低平均值0.69±0.91μIU/m L(p=0.000)。术后FT3较术前平均值4.66±1.00 pmol/L升高,最高为术后第一天(12.08±8.57 pmol/L)(p=0.003);术后FT4较术前平均值11.15±2.70 pmol/L升高,最高升到术后第一天(24.09±10.91 pmol/l)(p=0.000)。术后,仅有1例合并一过性甲亢的患者(5.9%)出现严重心悸症状,予口服"β-受体阻滞剂25 mg bid"治疗后症状明显缓解。PTX术后甲状腺机能亢进的发生不受年龄、透析龄等一般情况的影响,但其发生率与SHPT严重程度、手术时间呈明显正相关。结论:SHPT患者行PTX术后一过性甲亢的发生率较高,PTX手术前后应对甲状腺功能进行常规监测。Objective:The purpose of this study was to explore the occurrence and possible related factors of transient hyperthyroidism after PTX operation in SHPT patients.Methods:Since May 2018,28 patients who were admitted to our hospital for PTX due to SHPT were collected,and their thyroid function was regularly reviewed before and after surgery,and the heart rate and the symptoms such as uneasiness before and after the operation were recorded.Results:The preoperative thyroid function of the enrolled patients was normal,and the postoperative TSH was reduced from the preoperative average of 1.96±0.94μIU/m L to the lowest average of 0.69±0.91μIU/m L(p=0.000)on the fourth day after surgery.FT3 and FT4 from the preoperative average of 4.66±1.00 pmol/l and11.15±2.70 pmol/L increased to 12.08±8.57 pmol/L(p=0.003)and 24.09±10.91 pmol/L(p=0.000)after operation on the first day after operation,respectively.Only 1 patient(5.9%)with transient hyperthyroidism had severe palpitation after the operation,and the symptoms were significantly relieved after the oral administration of"beta blockers 25 mg bid".The occurrence of postoperative hyperthyroidism was not affected by general conditions such as age and dialysis age,but was positively correlated with SHPT severity and operation time.Conclusion:The incidence of transient parathyroidism was higher in SHPT patients after PTX,which was related to the operation time and total mass of parathyroid gland excised during operation.

关 键 词：继发性甲状旁腺机能亢进 甲状旁腺切除术 一过性甲状腺机能亢进 

分 类 号：R653[医药卫生—外科学] R619.9[医药卫生—临床医学]