甲状旁腺近全切加自体移植治疗肾源性甲状旁腺功能亢进初步疗效研究  

A preliminary study on the efficacy of Subtotal Parathyroidectomy with Autotransplantation in renal secondary hyperparathyroidism

作　　者：廖亦秦 袁芊芊 郑乐葳 吴高松 LIAO Yiqin;YUAN Qianqian;ZHENG Lewei(Department of Thyroid and Breast Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院甲状腺乳腺外科,430071

出　　处：《临床外科杂志》2021年第8期757-760,共4页Journal of Clinical Surgery

摘　　要：目的探讨甲状旁腺近全切除+自体移植术(subtotal parathyroidectomy with autotransplantation,SPTX+AT)治疗继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的安全性及有效性。方法 2019年1月~2019年10月收治的SHPT病人54例,行SPTX+AT治疗。收集病人术前及术后临床症状、甲状旁腺激素(parathyroid hormone,PTH)水平、血电解质水平信息,术后每3个月对上述指标进行随访,为期至少1年,判断手术安全性及有效性。结果 54例病人均顺利完成手术,术后症状有所好转,PTH、血钙、血磷水平均下降,差异有统计学意义(P <0.05)。以PTH低于150 pg/ml或下降幅度超过70%为有效进行判断,51例(94.4%)手术有效。8例(14.8%)出现低钙血症,随访第3个月时均稳定至正常范围。随访1年,共4例(7.4%)复发。结论 SPTX+AT治疗SHPT疗效确切,具有可行性;术后低钙血症发生率较低,复发后再次手术相对简单,手术安全性较好,相较于现有术式有一定优势。Objective To investigate the safety and effectiveness of subtotal parathyroidectomy with autotransplantation( SPTX + AT) for the treatment of secondary hyperparathyroidism. Methods Fifty-four patients with SHPT from January 2019 to October 2019 were collected and treated with SPTX +AT. Information on patients ’ preoperative and postoperative clinical symptoms,PTH levels,and blood electrolyte levels were collected,and the above indicators were followed up every 3 months after surgery for a period of at least 1 year to judge the safety and effectiveness of the surgery. Results Fifty-four patients who met the inclusion criteria successfully completed the surgery,and their postoperative symptoms improved and their PTH,blood calcium and blood phosphorus levels decreased( P < 0. 05). The surgery was effective in 51( 94. 4%) cases with PTH below 150 pg/ml or a decrease of more than 70%. 8( 14. 8%) patients developed hypocalcemia,which was stabilized to normal range in the third month of follow-up. There were 4( 7. 4%) cases of recurrence at 1 year of follow-up. Conclusion The efficacy of SPTX + AT in treating SHPT is accurate and feasible;the incidence of hypocalcemia after surgery is low,and reoperation after recurrence is relatively simple and safe,which has certain advantages over the existing procedures.

关 键 词：继发性甲状旁腺功能亢进 甲状旁腺切除术 慢性肾病 

分 类 号：R653[医药卫生—外科学]