超声引导下经皮激光消融治疗原发性甲状旁腺功能亢进症  

Ultrasound-guided percutaneous laser ablation for primary hyperparathyroidism

作　　者：施倩[1] 孙永康[1] 唐胜飞 练锋[1] SHI Qian;SUN Yongkang;TANG Shengfei;LIAN Feng(Department of Medical Ultrasound,Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]上海中医药大学附属第七人民医院超声医学科,上海200137

出　　处：《肿瘤影像学》2020年第4期370-374,共5页Oncoradiology

摘　　要：目的:探讨超声引导下经皮激光消融治疗原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的可行性、安全性及治疗价值。方法:对3例PHPT患者行激光消融,功率3 W,采用多点、移动消融法,术后即刻超声造影评估消融范围。术前、术后检测全段甲状旁腺素(intact parathyroid hormone,iPTH)、血钙、血磷、碱性磷酸酶(alkaline phosphatase,ALP)等,并测量甲状旁腺结节容积的变化率。密切随访12个月。结果:3例PHPT结节经超声造影证实均一次性彻底消融。术后12个月,iPTH由术前(578.37±568.66)ng/L降为(92.62±19.83)ng/L,血钙由(3.20±0.43)mmol/L降为(2.35±0.03)mmol/L(P<0.05),ALP由(303.53±188.29)U/L下降为(99.70±7.86)U/L,血磷由术前(0.830±0.098)mmol/L上升为(0.923±0.120)mmol/L;术后iPTH显著下降,血钙、血磷及ALP测值均持续正常。PHPT结节容积缩小率>95.73%。术后1例发生"骨饥饿综合征",予以口服补钙后好转,未发生喉返神经损伤等严重并发症。结论:超声引导下经皮激光消融治疗PHPT是一种微创、安全、有效的方法,可显著降低iPTH、血钙值,并显著缩小PHPT结节,有望成为治疗PHPT的新方法之一。Objective:To investigate the feasibility,safety and therapeutic value of ultrasound-guided percutaneous laser ablation for primary hyperparathyroidism(PHPT).Methods:Three patients with PHPT were treated with laser ablation.The multi-point ablation power was 3 W,and the contrast-enhanced ultrasound was used to evaluate the ablation range immediately after surgery.The changes of intact parathyroid hormone(iPTH),serum calcium,serum phosphorus,alkaline phosphatase(ALP)and parathyroid nodule volume were measured before and after operation for 12 months.Results:A total of 3 cases of PHPT nodules were completely ablated at one time,confirmed by contrast-enhanced ultrasound.12 months after operation,iPTH decreased from(578.37±568.66)ng/L to(92.62±19.83)ng/L,serum calcium decreased from(3.20±0.43)mmol/L to(2.35±0.03)mmol/L(P<0.05),and ALP decreased from(303.53±188.29)U/L to(99.70±7.86)U/L.Serum phosphorus rose from(0.830±0.098)mmol/L to(0.923±0.120)mmol/L.Postoperative iPTH decreased significantly.The blood calcium,blood phosphorus and ALP continued to be normal levels.The nodule volume reduction rate was>95.73%.One case of postoperative"bone starvation syndrome"was treated with oral calcium supplementation,and no serious complications such as recurrent laryngeal nerve injury occurred.Conclusion:Ultrasound-guided percutaneous laser ablation of PHPT is a minimally invasive,safe and effective method,which can significantly reduce iPTH,serum calcium measurements and significantly reduce the volume of parathyroid nodules.It can be a new method for the treatment of PHPT.

关 键 词：原发性甲状旁腺功能亢进症 激光消融 甲状旁腺激素 血清钙 

分 类 号：R445.1[医药卫生—影像医学与核医学]