尿毒症继发性甲状旁腺功能亢进症患者应用甲状旁腺全切除加自体移植术5年随访资料分析  

Total parathyroidectomy Combined with autotransplantation in the treatment of uremic secondary hyperparathyroidism:a single-center cohort study of 5 years

作　　者：罗明乾 冼翠华 贺芳 胡菂菂 姜松青 李尚仁 赵景林 石晓峰 LUO Mingqian;XIAN Cuihua;HE Fang;HU Didi;JIANG Songqing;LI Shangren;ZHAO Jinglin;SHI Xiaofeng(Affiliated Jiangmen Hospital of sun Yat-Sen university,Jiangmen 529070,China)

机构地区：[1]中山大学附属江门医院,广东江门529000

出　　处：《临床医药实践》2021年第3期175-179,共5页Proceeding of Clinical Medicine

基　　金：江门市科技局医疗卫生科技计划项目(项目编号:2018A049)。

摘　　要：目的:观察慢性肾脏病(5D期)患者因继发性甲状旁腺功能亢进症(SHPT)行甲状旁腺全切除加自体移植术(TPTX+AT)的远期临床疗效。方法:回顾性分析2011年3月—2014年12月慢性肾脏病(5D期)患者因继发性甲状旁腺功能亢进症行TPTX+AT的41例患者的临床资料(随访至2019年12月),收集患者术前、术后全段甲状旁腺激素及血清钙、磷、碱性磷酸酶等变化情况,临床症状改善情况,复发和死亡情况,判断临床疗效。结果:共41例患者,年龄(47.0±9.0)岁,透析(76.0±38.9)个月。患者术后1周、1个月、6个月各时间点血全段甲状旁腺素(iPTH)、血清磷、血清钙均较术前显著下降(P<0.001)。术后早期甲状旁腺功能亢进持续状态2例,术后第1年复发5例,其中3例共行5次移植物切除手术。随访期满共有27例存活,血清钙(2.17±0.26)mmol/L,血清磷(2.16±0.47)mmol/L,iPTH达标率70.4%(19/27)。结论:甲状旁腺全切除加自体移植术,能安全、有效治疗尿毒症难治性SHPT,可以改善SHPT患者远期预后。Objective:To investigate clinical characters and long-term effect of total parathyroidectomy combined with autotransplantation(TPTX+AT)in the treatment of uremic patients with secondary hyperparathyroidism(SHPT).Methods:All 41 refractory SHPT patients in chronic kidney disease(5D)underwent PTX+AT between March 2011 to Dec 2014 were enrolled and were followed for more than 5 years until Dec.2019.The clinical efficacy by comparing the levels of intact parathyroid hormone(iPTH),serum calcium,serum phosphate,clinical symptoms and numbers of survivors before and after operation were observed.Results:The levels of iPTH,serum phosphorus,serum calcium in 1 week,1 month and 6 months after operation significantly decreased than those before operation(P<0.001).2 cases were founded due to persistant hyperparathyroidism and 5 cases were observed due to recurrent hyperparathyroidism in the first year after operation.Re-operation was performed in 3 cases for 5 times.27 cases survived,serum calcium(2.17±0.26)mmol/L,serum phosphate(2.16±0.47)mmol/L,iPTH compliance rate is 70.4%(19/27).Conclusion:PTX+AT is a safe and effective treatment with robust survival benefit for uremic patients with refractory SHPT.

关 键 词：甲状旁腺切除术 自体移植 尿毒症 甲状旁腺功能亢进症 继发性 

分 类 号：R692.5[医药卫生—泌尿科学]