甲状旁腺全切除术治疗终末期肾脏病合并难治性继发性甲状旁腺功能亢进症的效果  

Effect of total parathyroidectomy on end stage renal disease complicated with refractory secondary hyperparathyroidism

作　　者：许杰[1] 李程亮[1] 王敏娟[1] XU Jie;LI Chengliang;WANG Minjuan(the First Affiliated Hospital of Xi'an Medical University,Xi'an 710000,China)

机构地区：[1]西安医学院第一附属医院,陕西西安710000

出　　处：《临床医学研究与实践》2021年第4期45-47,共3页Clinical Research and Practice

基　　金：陕西省卫生健康科研基金(No.2018D076)。

摘　　要：目的总结甲状旁腺全切除术(TPTX)治疗终末期肾脏病(ESRD)合并难治性继发性甲状旁腺功能亢进症(SHPT)的过程及疗效,为外科治疗难治性SHPT提供参考。方法回顾性分析西安医学院第一附属医院收治的13例行TPTX治疗的ESRD合并难治性SHPT患者的临床资料,比较患者术前与术后的血钙、血磷、全段甲状旁腺素(iPTH)及临床症状发生情况。结果13例患者术后无一例死亡和喉返神经损伤,7例(53.85%)发生低钙血症,1例(7.69%)术后出现甲状旁腺功能减退。术后1 d、1周、1个月、3个月、6个月,患者的血钙、血磷及iPTH水平均较术前明显降低(P<0.05)。术后1、3、6个月,存在骨痛、皮肤瘙痒、肌无力、失眠症状的患者占比均明显低于术前(P<0.05)。结论TPTX是治疗继发于ESRD的难治性SHPT有效、安全的方法。Objective To summarize the process and efficacy of total parathyroidectomy(TPTX)in the treatment of end stage renal disease(ESRD)with refractory secondary hyperparathyroidism(SHPT),so as to provide reference for surgical treatment of refractory SHPT.Methods The clinical data of 13 ESRD patients with refractory SHPT treated with TPTX in the first affiliated hospital of Xi'an medical university were retrospectively analyzed.The blood calcium,blood phosphorus,total parathyroid hormone(iPTH)and clinical symptoms before and after operation were compared.Results There was no death or recurrent laryngeal nerve injury in 13 patients.Hypocalcemia occurred in 7 patients(53.85%)and hypoparathyroidism occurred in 1 patient(7.69%).At 1 d,1 week,1 month,3 months and 6 months after operation,the levels of serum calcium,phosphorus and iPTH were significantly lower than those before operation(P<0.05).At 1,3 and 6 months after operation,the proportions of patients with bone pain,skin itching,muscle weakness and insomnia were significantly lower than those before operation(P<0.05).Conclusion TPTX is an effective and safe treatment method for refractory SHPT secondary to ESRD.

关 键 词：继发性甲状旁腺功能亢进 甲状旁腺切除术 终末期肾病 

分 类 号：R653[医药卫生—外科学]