多学科协作围手术期管理下尿毒症继发甲状旁腺功能亢进两种术式的对比研究  

Comparative study of two surgical methods for uremia secondary hyperparathyroidism under perioperative management of multidisciplinary cooperation

作　　者：崔恒锋[1,3] 茆俊花 夏盛成 王爱坤[1,3] 王立胜 CUI Heng-feng;MAO Jun-hua;XIA Sheng-cheng;WANG Ai-kun;WANG Li-sheng(Department of General Surgery,The Third People's Hospital of Yancheng City,Jiangsu Province,Yancheng 224000,China;Department of Nephrology,The Third People's Hospital of Yancheng City,Jiangsu Province,Yancheng 224000,China;Jiangsu Vocational College of Medicine,Yancheng 224000,China)

机构地区：[1]江苏省盐城市第三人民医院普外科,江苏盐城224000 [2]江苏省盐城市第三人民医院肾内科,江苏盐城224000 [3]江苏医药职业学院,江苏盐城224000

出　　处：《中国现代普通外科进展》2022年第3期191-195,共5页Chinese Journal of Current Advances in General Surgery

基　　金：江苏医药职业学院临床学院专项科研发展基金(20209126)。

摘　　要：目的:探讨多学科协作管理下尿毒症继发甲状旁腺功能亢进(SHPT)行甲状旁腺全切除术(TPTX)与TPTX+自体移植(AT)的对比研究。方法:通过多学科协作下对TPTX与TPTX+AT两组患者术后血钙、血磷、全段甲状旁腺激素(iPTH)、左室射血分数、两室心室结构、心脏瓣膜钙化、血钙钙化、手术时间、出血量、住院费用进行比较。结果:TPTX组复发率明显低于TPTX+AT组(P<0.05),甲状旁腺功能减退发生率TPTX+AT组低于TPTX组(P<0.05),口周麻木及抽搐发生率两组相比差异无统计学意义(P>0.05)。两组患者术后血钙、血磷及iPTH较术前均有明显下降(P<0.05),其中术后血钙及iPTH两组差异均无统计学意义(P>0.05);术后1个月至术后1年,TTPX组血磷控制明显较TPTX+AT组低(P<0.001)。两组左室射血分数随时间延长有增加趋势(P<0.05),但两组间相比差异无统计学意义(P>0.05);两组心室结构均呈下降趋势(P<0.05),但两组相比差异无统计学意义(P>0.05);两组心脏瓣膜钙化及血管钙化均无明显改变。两组住院时间差异无统计学意义(P>0.05),TPTX组的手术时间、出血量、住院费用均低于TPTX+AT组(P<0.05)。术前甲状旁腺定位B超检查准确率75%,ECT扫描准确率88.7%,同时行两种检查准确率91.1%。结论:TPTX虽然术后甲状旁腺功能减退发生率较高,但可控,而在术后复发率、手术时间、住院费用等方面低于TPTX+AT组,多学科协作在TPTX加或不加AT围手术期管理中体现出很好的优越性。Objective:To explore the comparative study of total parathyroidectomy(TPTX)and TPTX+autotransplantation(AT)for uremic patients with secondary hyperparathyroidism(SHPT)under multidisciplinary management.Methods:through multidisciplinary collaboration,TPTX and TPTX+AT two groups of patients with postoperative blood calcium,phosphorus,iPTH,left ventricular ejection fraction,two ventricular structure,cardiac valve calcification,blood calcium calcification,operation time,blood loss,hospitalization expenses were compared.Results:The recurrence rate of TPTX group was significantly lower than that of TPTX+AT group(P<0.05);The incidence of hypoparathyroidism in TPTX+AT group was lower than that in TPTX group(P<0.05).There was no significant difference in the incidence of perioral numbness and convulsion between the two groups(P>0.05).The serum calcium,phosphorus and iPTH of the two groups were significantly decreased after operation(P<0.05),and there was no significant difference between the two groups(P>0.05);From 1 month to 1 year after operation,blood phosphorus control in TPTX group was significantly lower than that in TPTX+AT group(P<0.001).The left ventricular ejection fraction of the two groups increased with time(P<0.05),but the difference between the two groups was statistically significant(P>0.05);There was no significant difference between the two groups(P>0.05);There were no significant changes in cardiac valve calcification and vascular calcification in the two groups.There was no significant difference in the length of hospital stay between the two groups(P>0.05).The operation time,blood loss and hospitalization expenses of TPTX group were lower than those of TPTX+AT group(P<0.05).The accuracy of parathyroid localization was 75%by B-ultrasound,88.7%by ECT,and 91.1%by both methods.Conclusion:Although the incidence of postoperative hypoparathyroidism in TPTX group is high,it can be controlled,and the recurrence rate,operation time and hospitalization cost in TPTX group are lower than those in TPTX+AT group,Mul

关 键 词：甲状旁腺全切除术 继发性甲状旁腺功能亢进 多学科协作 围手术期 

分 类 号：R653[医药卫生—外科学]