甲状旁腺全切术治疗难治性继发性甲状旁腺功能亢进症  

Total parathy roidectomy in the treatment of refractory secondary hyperparathy roidism

作　　者：岳文慧 于铁莉[2] 项清华 李连贺 YUE Wenhui;YU Tieli;XIANG Qinghua;LI Lianhe(Department of Otolaryngology,Chaoyang Center Hospital,Chaoyang,Liaoning,122000,China;Department of Anesthesia,Affliated Hospital of Chengde Medical College,Chengde,Hebei,067000,China)

机构地区：[1]辽宁省朝阳市中心医院耳鼻咽喉科,辽宁朝阳122000 [2]河北省承德医学院附属医院麻醉科,河北承德067000

出　　处：《中国耳鼻咽喉头颈外科》2020年第2期87-90,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的研究甲状旁腺全切术(totally parathyroidectomy,TPTX)治疗难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的临床疗效。方法对21例药物治疗抵抗的难治性SHPT患者行TPTX,观察术前术后血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙、血磷、碱性磷酸酶变化情况,并观察术后患者临床症状改善、静脉补钙时间及术后并发症情况。结果21例患者共切除甲状旁腺83枚,全部患者骨痛、皮肤瘙痒等临床症状明显缓解或消失,术后iPTH、血钙、血磷明显下降,与术前比较有统计学意义(P<0.05),术前术后碱性磷酸酶变化无统计学意义(P>0.05),全部患者均于术后0~8天内停止静脉补钙,术后静脉补钙时间(3.43±2.31)天,术后静脉补钙时间与术前PTH水平有相关性(P<0.05),与术前碱性磷酸酶水平无相关性(P>0.05),术后随访1个月-3年,无顽固性低钙血症出现,无严重术后并发症出现,无术后复发。结论TPTX疗效确切,术后复发率低,无严重术后并发症,是治疗难治性SHPT的安全有效手术方式。OBJECTIVE To study the clinical effect of total parathyroidectomy in the treatment of refractory secondary hyperparathyroidism.METHODS Twenty one patients with refractory secondary hy perparathyroidism were treated with total parathyroidectomy,the changes of intact parathyroid hormone,serum calcium,serum phosphorus and alkaline phosphatase were observed before and after operation,and the clinical symptoms,time of intravenous calcium supplementation and postoperative complications were recorded.RESULTS In 21 patients,83 parathyroid glands were removed,bone pain,skin itching and other clinical symptoms were significantly relieved or disappeared after operation.The intact parathyroid.hormone,serum calcium and serum phosphorus decreased significantly after operation,and there was statistically significance(P<0.05).There was no signifcant difference in alkaline phosphatase before and after operation(P>0.05).All patients stopped intravenous calcium supplementation within 0 or 8 days after operation,and the average postoperative intravenous calcium supplementation time was(3.43+2.31)days.The time of intravenous calcium supplementation was correlated with the level of intact parathyroid hormone before operation(P<0.05),but not correlated with the level of alkaline phosphatase before operation(P>0.05).The patients were followed up from 1 month to 3 years.No intractable hypocalcemia,no serious postoperative complications and no postoperative recurrence were found.CONCLUSION Total parathyroidectomy is a safe and effective method for the treatment of refractory secondary hyperparathyroidism for its definite curative effect,low recurrence rate and no serious postoperative complications.

关 键 词：甲状旁腺功能亢进症 继发性 甲状旁腺切除术 低钙血症 甲状旁腺激素 

分 类 号：R653[医药卫生—外科学]