不同术式治疗继发性甲状旁腺功能亢进临床疗效的Meta分析  

Effect of different surgical procedures of parathyroidectomy on secondary hyperparathyroidism:a meta-analysis

作　　者：吕凛生[1] 李少敏[2] 叶玉球 胡文涛 刘迅[2] Lyu Linsheng;Li Shaomin;Ye Yuqiu;Hu Wentao;Liu Xun(Operation Room,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Nephrology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院手术室,广州510630 [2]中山大学附属第三医院肾内科,广州510630

出　　处：《中华肾脏病杂志》2019年第12期914-921,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81370866、81873631)。

摘　　要：目的探讨甲状旁腺全切+自体移植(TPTX+AT)和甲状旁腺全切(TPTX)两种术式治疗继发性甲状旁腺功能亢进(SHPT)临床疗效的差异。方法检索PubMed、EMBASE、Cochrane Library从数据库建库至2017年6月的相关文献,纳入筛选后符合要求文献并进行Meta分析,比较TPTX+AT组和TPTX组患者术后SHPT症状改善、SHPT持续、复发、再次手术、术后甲状旁腺功能低下、手术时间和住院时间的差异。结果11项研究共1212例患者被纳入本研究。Meta分析结果显示,两组患者术后SHPT症状改善和术后SHPT持续的发生率的差异无统计学意义(分别RR=1.03,P=0.70;RR=0.81,P=0.67),TPTX组术后SHPT复发和再次手术率低于TPTX+AT组(RR=0.25,P<0.01;RR=0.19,P<0.01)。TPTX组术后甲状旁腺功能低下的发生率较高(RR=2.68,P<0.01),手术时间较短(MD=-17.3,P=0.01),两组住院时间的差异无统计学意义(MD=-0.06,P=0.98)。结论与TPTX+AT术式比较,TPTX术式可减少术后SHPT的复发率和再次手术率,缩短手术时间,但术后甲状旁腺功能低下发生率较高。Objective To evaluate the effect of total parathyroidectomy and autotransplantation(TPTX+AT)and total parathyroidectomy(TPTX)on secondary hyperparathyroidism(SHPT).Methods PubMed,EMBASE and Cochrane library were searched from inception to June 2017 for relative studies,which were screened according to inclusion criteria.Meta-analysis of included study were conducted to compare the improvement of symptoms,persistent SHPT,recurrent SHPT,reoperation,hypoparathyroidism,duration of operation and hospitalization between TPTX+AT group and TPTX group.Results A total of 11 studies with 1212 patients were included.Results of meta-analyses showed no difference between TPTX+AT and TPTX regarding improvement of symptoms and persistent SHPT(RR=1.03,P=0.70;RR=0.81,P=0.67,respectively),but TPTX was associated with lower risks of recurrent SHPT and reoperation(RR=0.25,P<0.01;RR=0.19,P<0.01).Patients with TPTX had higher rate of hypoparathyroidism(RR=2.68,P<0.01)but shorter time of operation(MD=-17.3,P=0.01).Durations of hospitalization were similar between the two groups(MD=-0.06,P=0.98).Conclusion Compared with TPTX+AT,TPTX reduces the risks of recurrent SHPT,reoperation and operation time,but has higher risk of hypoparathyroidism.

关 键 词：甲状旁腺功能亢进症 继发性 甲状旁腺切除术 META分析 

分 类 号：R65[医药卫生—外科学]