尿毒症继发甲状旁腺功能亢进合并甲状腺结节患者的外科治疗  

Surgical treatment of uremic secondary hyperparathyroidism complicated with thyroid nodules

作　　者：张磊[1] 汤铜[1] 史加宁[1] 李佳[1] 郑璐[1] 余慧 王德光[2] 郝丽[2] ZHANG Lei;TANG Tong;SHI Jianing;LI Jia;ZHENG Lu;YU Hui;WANG Deguang;HAO Li(Department of Thyroid and Breast Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei,230601,China;Department of Nephrology,the Second Affiliated Hospital of Anhui Medical University)

机构地区：[1]安徽医科大学第二附属医院甲乳外科,合肥230601 [2]安徽医科大学第二附属医院肾脏内科

出　　处：《临床耳鼻咽喉头颈外科杂志》2019年第7期658-661,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：安徽医科大学校临床科学研究项目(No:2015xkj110);安徽省高校自然科学基金研究项目(No:KJ2013Z155)

摘　　要：目的:探讨尿毒症继发甲状旁腺功能亢进(SHPT)合并甲状腺结节(TN)患者的外科治疗方法。方法:回顾性分析安徽医科大学第二附属医院在2014-03-2017-08期间收治的26例SHPT合并TN患者的临床资料。结果:患者均行甲状旁腺全切,同时前臂皮下微量移植2.0mm×2.0mm的甲状旁腺颗粒。术后6个月、12个月的全段甲状旁腺激素、碱性磷酸酶、血钙、血磷水平以及钙磷乘积与术前相比均显著降低(P<0.01);KDQOL-SFTM量表评估生存质量明显高于术前(P<0.01)。合并的TN均同时手术,砂砾样钙化与甲状腺乳头状癌显著相关(P<0.01)。结论:甲状旁腺全切加前臂皮下微量自体移植及同时手术治疗TN可应用于SHPT合并TN的患者,在妥善处理患者TN的同时可以显著改善SHPT相关预后和生存质量;应警惕SHPT背景下的TN有恶性可能,尤其是存在砂砾样钙化者。Objective:To investigate the surgical treatment of secondary hyperparathyroidism(SHPT)with thyroid nodule(TN)in uremic patients.Method:The clinical data of 26 patients diagnosed as SHPT combined with TN were retrospectively analyzed.Result:The patients underwent total parathyroidectomy and parathyroid granuless were transplanted subcutaneously into the forearm.The levels of parathyroid hormone,alkaline phosphatase,serum calcium,serum phosphorus and calcium-phosphorus product in 6 months and 12 months after operation were significantly lower than those before operation(P<0.01).The quality of life assessed by KDQOLSFTMscale was significantly higher than that before operation(P<0.01).Concomtiant TN was operated simultaneously,and gravel calcification was significantly associated with papillary thyroid carcinoma(P<0.01).Conclusion:Total parathyroidectomy plus subcutaneous minimal forearm autograft and concurrent surgery with TN are feasible,and can not only properly treat TN,but also significantly improve SHPT-related prognosis and quality of life.We should be alert to the possibility of malignant TN in SHPT background,especially those with grit calcification.

关 键 词：甲状旁腺功能亢进症 继发性 甲状旁腺切除术 自体前臂移植 甲状腺乳头状癌 

分 类 号：R736.1[医药卫生—肿瘤]