甲状旁腺全切+自体移植术治疗继发性甲状旁腺功能亢进症疗效分析  

Therapeutic evaluation of total parathyroidectomy with autotransplantation in the treatment of secondary hyperparathyroidism

作　　者：王萌[1] 魏丽敏 刘华[1] 史珂慧[1] 蒋红利[1] Wang Meng;Wei Limin;Liu Hua;Shi Kehui;Jiang Hongli(Department of Blood Purification,The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院血液净化科

出　　处：《中华肾病研究电子杂志》2019年第4期170-175,共6页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：陕西省自然科学基础研究计划(2017JM8141);陕西省重点研发计划一般项目(2019SF-074)

摘　　要：目的探讨甲状旁腺全切+自体移植术(t PTX+AT)治疗维持性血液透析患者继发性甲状旁腺功能亢进症(SHPT)的有效性、安全性以及术后低钙的危险因素。方法纳入我院2013年1月至2016年11月因SHPT行t PTX+AT手术的维持性血液透析患者93例,收集术前术后症状、血钙、磷、碱性磷酸酶(ALP)、全段甲状旁腺激素(i PTH)、病理类型、并发症等临床资料。依据术后24 h血钙水平分为正常血钙组(Ca≥2. 11 mmol/L)及低钙血症组(Ca <2. 11 mmol/L),应用单因素分析及逐步Logistic回归分析术后早期低钙血症的危险因素。结果手术成功率92. 5%。切除360枚甲状旁腺腺体,异位甲状旁腺10枚。病理结果多为腺瘤样增生(96. 4%)。同术前相比,术后血清i PTH、磷、ALP明显下降(P <0. 05)。低钙血症是术后最常见并发症,发生率82. 8%,血钙水平与术前血钙、年龄正相关(r=0. 300,P <0. 01;r=0. 265,P <0. 01),与术前i PTH、ALP水平负相关(r=-0. 461,P <0. 01;r=-0. 477,P <0. 01)。术前低血钙(OR=0. 113,P=0. 045)、高ALP水平(OR=1. 050,P <0. 001)、高i PTH水平(OR=1. 002,P=0. 004)是术后早期低钙血症发生的独立危险因素。结论t PTX+AT可以安全、有效、快速的降低维持性血液透析患者血清i PTH水平,改善机体的钙磷代谢紊乱,但需重视并积极纠正术后低钙血症。针对存在术前低血钙、高i PTH及高ALP水平等高危因素的患者,术前积极纠正低钙血症可能是预防术后低钙的有效干预方式。Objective To evaluate the safety and effectiveness of total parathyroidectomy combining autotransplantation( t PTX + AT) in the treatment of secondary hyperparathyroidism( SHPT) of patients with maintenance hemodialysis,and to investigate the risk factors for early hypocalcemia after parathyroidectomy.Methods Ninety-three cases of maintenance hemodialysis patients were enrolled who underwent t PTX + AT surgery due to SHPT in the hospital from January 2013 to November 2016. Clinical data were collected including preoperative and postoperative symptoms,serum calcium,serum phosphorus,serum alkaline phosphatase( ALP),serum intact parathyroid hormone( i PTH),pathological types,and complications.According to the blood calcium level at 24 h after operation,the patients were divided into two groups,the normal blood calcium group( Ca ≥ 2. 11 mmol/L) and hypocalcemia group( Ca < 2. 11 mmol/L).Univariate analysis and stepwise logistic regression were used to analyze the risk factors for early postoperative hypocalcemia. Results The success rate of surgery was 92. 5%,with excision of 360 parathyroid glands and 10 ectopic parathyroid glands. The pathological results showed mostly adenoma-like hyperplasia( 96. 4%). Compared with those preoperative levels,the levels of postoperative i PTH,serum phosphorus,and serum ALP decreased significantly( P < 0. 05). Hypocalcemia was the most common complication after the operation with the incidence rate of 82. 8%. The postoperative serum calcium level was positively correlated with the preoperative blood calcium and age( r = 0. 300,P < 0. 01;r = 0. 265,P < 0. 01),and negatively correlated with the levels of serum i PTH and serum ALP( r =-0. 461,P < 0. 01;r =-0. 477,P < 0. 01). The preoperative low blood calcium( OR = 0. 113,P = 0. 045),high serum ALP level( OR =1. 050,P < 0. 001),and high serum i PTH level( OR = 1. 002,P = 0. 004) were independent risk factors for early postoperative hypocalcemia. Conclusion t PTX + AT could safely,effectively,and rapidly reduce the level of serum i PT

关 键 词：甲状旁腺全切+自体移植术 继发性甲状旁腺功能亢进症 低钙血症 

分 类 号：R653[医药卫生—外科学]