甲状旁腺全切除联合前臂自体移植术早期干预治疗继发性甲状旁腺功能亢进症临床应用  

Clinical application of total parathyroidectomy combined with forearm autotransplantation in early intervention treatment of secondary hyperparathyroidism

作　　者：郭朝阳[1] 何德[1] 徐辉[2] 秦章禄[1] GUO Chaoyang;HE De;XU Hui;QIN Zhanglu(Department of Gastrointestinal Surgery,Pingxiang People′s Hospital in Jiangxi Province,Pingxiang337000,China;Pharmacy Department,Pingxiang People′s Hospital in Jiangxi Province,Pingxiang337000,China)

机构地区：[1]江西省萍乡市人民医院胃肠外科,江西萍乡337000 [2]江西省萍乡市人民医院药剂科,江西萍乡337000

出　　处：《中国现代医生》2022年第4期31-34,共4页China Modern Doctor

基　　金：江西省卫生计生委科技计划项目(20197281)。

摘　　要：目的探讨甲状旁腺全切除联合自体前臂皮下移植术(Tpx+AT)早期干预治疗慢性肾功能衰竭继发性甲状旁腺功能亢进症(SHPT)的临床疗效。方法收集2016年11月至2020年3月在江西省萍乡市人民医院行Tpx+AT治疗的52例SHPT患者的随访临床资料,分为常规干预组(有临床症状)32例,早期干预组(无临床症状)20例,两组均接受甲状旁腺全切除加自体前臂皮下移植术,对两组病例术前、术后及随访的血全段甲状旁腺激素(iPTH)、血钙进行统计学分析,观察术后并发症和复发情况。结果与术前相比,两组术后1、5、10 d及1、3、6个月iPTH、血钙均显著下降,差异有统计学意义(P<0.05);iPTH术后6个月与术后1 d比较,差异无统计学意义(P>0.05);血钙术后6个月与术前比较,差异无统计学意义(P>0.05)。两组均无喉返神经损伤;常规干预组骨痛及皮肤瘙痒等于术后1周内逐渐缓解,1例患者术后复发。结论甲状旁腺全切除加自体前臂皮下移植术是治疗SHPT的安全有效手段,早期外科干预可提高透析患者的生存质量。Objective To investigate the clinical effectiveness of total parathyroidectomy combined with autotransplantation(Tpx+AT)early intervention in the treatment of secondary hyperparathyroidism(SHPT)in chronic renal failure.Methods The follow-up clinical data of 52 SHPT patients who underwent Tpx+AT treatment in Pingxiang People′s Hospital in Jiangxi Province from November 2016 to March 2020 were collected.They were divided into the conventional intervention group(with clinical symptoms,n=32)and the early intervention group(with no clinical symptoms,n=20).Both groups underwent total parathyroidectomy plus autologous forearm subcutaneous transplantation.Statistical analysis was performed on preoperative,postoperative,and follow-up blood intact parathyroid hormone(iPTH)and serum calcium in the two groups.The postoperative complications and recurrence were observed.Results Compared with that before the operation,iPTH and serum calcium were significantly decreased at 1,5,10 days and 1,3,6 months after the operation in both groups(P<0.05).The iPTH had no statistical difference between 6 months and one day after the operation(P>0.05).There was no statistically significant difference in blood calcium between 6 months after the operation and before the operation(P>0.05).No recurrent laryngeal nerve was injured.Symptoms of the conventional intervention group such as bone and joint pain and skin itching were gradually relieved within one week after the operation.One patient relapsed after the operation.Conclusion Total parathyroidectomy plus autologous forearm subcutaneous transplantation is a safe and effective treatment for SHPT.Early surgical intervention can improve the quality of life of dialysis patients.

关 键 词：慢性肾脏病 继发性甲状旁腺功能亢进症 甲状旁腺切除术 自体移植 

分 类 号：R692[医药卫生—泌尿科学]