老年原发性甲状旁腺功能亢进症的外科诊治  

Diagnosis and surgical treatment of primary hyperparathyroidism in the elderly people

作　　者：王刚[1] 金仲田[1] 王福顺[1] 李涛[1] Wang Gang;Jin Zhongtian;Wang Fushun;Li Tao(Department of Hepatobiliary Surgery,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院肝胆外科,北京100044

出　　处：《中华内分泌外科杂志》2022年第1期28-31,共4页Chinese Journal of Endocrine Surgery

基　　金：北京市自然科学基金面上项目(7192212)。

摘　　要：目的分析老年原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者的临床特点,外科治疗的安全性和有效性。方法对北京大学人民医院肝胆外科2000年1月至2020年12月接受手术的179例PHPT患者,按照手术时年龄是否超过60岁,分为老年组(n=51)和非老年组(n=128),回顾分析两组的症状、合并症、术前及术后血钙、血磷、血碱性磷酸酶(alkaline phosphatase,ALP)、血甲状旁腺激素(parathyroid hormone,PTH)、手术治愈率、并发症发生率等临床资料。计量资料对比采用t检验,计数资料对比及单因素分析采用χ^(2)检验,用Logistic回归(前进法)进行多因素分析。结果相对于非老年组,老年组非特异症状(包括乏力、头晕、食欲下降、记忆力下降等)占比较高(21.6%vs 8.6%,P=0.019),老年组术前血ALP水平较低[(163.4±229.8)U/L vs(325.9±449.2)U/L,P=0.016],老年组术前合并较高比例的高血压病(47.1%vs 21.1%,P=0.001)、糖尿病(31.4%vs 10.9%,P=0.001)、冠心病(13.7%vs 3.1%,P=0.013)、肿瘤(13.7%vs 3.9%,P=0.025)。分析发现非特异症状占比高的相关因素包括高血钙[OR=4.936(95%CI 1.126-21.637),P=0.034]和低血磷[OR=0.011(95%CI 0.000-0.650),P=0.030]。两组的治愈率(94.1%vs 96.1%,P=0.564)和并发症发生率(27.5%vs 44.5%,P=0.127)差异无统计学意义。结论对老年PHPT患者的手术治疗安全、有效,应更加重视老年PHPT患者的外科诊治。Objective To analyze the clinical characteristics of PHPT in elderly patients,as well as the safety and effectiveness of surgical treatment.Methods 179 patients with PHPT treated from Jan.2000 to Dec.2020 were analyzed retrospectively.They were divided into elderly group(n=51)and non-elderly group(n=128)according to whether they were over 60 years old at the time of operation.The clinical data of symptoms,complications,preoperative and postoperative blood calcium,phosphorus,ALP,PTH,surgical cure rate and complication rate of the two groups were analyzed retrospectively.T-test was used for measurement data comparison.χ^(2) test was used for enumeration data comparison and single factor analysis.Logistic regression analysis(forward method)was used for multivariate analysis.Results The proportion of non-specific symptoms in the elderly group,including fatigue,dizziness,loss of appetite,memory decline,was higher than that in the non-elderly group(21.6%vs 8.6%,P=0.019).Elderly patients had lower blood ALP level[(163.4±229.8)U/L vs(325.9±449.2)U/L,P=0.016],higher proportion of preoperative hypertension(47.1%vs 21.1%,P=0.001),diabetes(31.4%vs 10.9%,P=0.001),coronary heart disease(13.7%vs 3.1%,P=0.013)and tumor(13.7%vs 3.9%,P=0.025).High proportion of non-specific symptoms was related to higher blood calcium[OR=4.936(95%CI 1.126-21.637),P=0.034]and lower blood phosphorus[OR=0.011(95%CI 0.000-0.650),P=0.030].Between the two groups there was no significant difference in cure rate(94.1%vs 96.1%,P=0.564)or complication rate(27.5%vs 44.5%,P=0.127).Conclusions The surgical treatment of elderly patients with PHPT also has high effectiveness and safety.More attention should be paid to surgical diagnosis and treatment of elderly patients.

关 键 词：原发性甲状旁腺功能亢进症 老年 外科手术 

分 类 号：R653[医药卫生—外科学] R736.2[医药卫生—临床医学]