甲状旁腺全切除术治疗肾性继发性甲状旁腺功能亢进症近期疗效观察  

Short-term effect of parathyroidectomy on renal secondary hyperparathyroidism

作　　者：魏常胜[1] 骆成玉 王以新[2] 张树琦[1] WEI Chang-sheng;LUO Cheng-yu;WANG Yi-xin;ZHANG Shu-qi(Department of General Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of General Practice,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院普外科,北京100029 [2]首都医科大学附属北京安贞医院全科医疗科,北京100029

出　　处：《中华实用诊断与治疗杂志》2022年第5期471-474,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：首都医学发展科研基金(20093113);北京市科技计划(Z131107002213145)。

摘　　要：目的观察肾性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者行甲状旁腺全切除术(total parathyroidectomy,TPTX)或TPTX联合自体移植术(total parathyroidectomy with autotransplantation,TPTX+AT)后血钙、血磷及血清全段甲状旁腺激素(intact parathyroid hormones,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)水平变化,探讨其治疗效果和安全性。方法肾性SHPT患者62例,行TPTX或TPTX+AT治疗。记录手术成功率及术后并发症发生情况;比较术前及术后1、3、6个月时血钙、血磷及血清iPTH、ALP水平;比较术前及术后6个月时骨痛视觉模拟评分(visual analogue scale,VAS)、皮肤瘙痒及睡眠障碍发生率;随访至2020年4月,记录术后SHPT复发及持续性甲状旁腺功能低下发生情况。结果62例患者中24例行TPTX,38例行TPTX+AT,手术成功率100%,行TPTX+AT者移植物存活率为86.8%,术后均未发生切口感染、喉部感觉神经丧失、失音等并发症,无围术期死亡。血钙、血磷及血清iPTH、ALP水平在术后1个月[(2.26±0.20)mmol/L、(1.09±0.29)mmol/L、73.74(64.50,86.26)ng/L、223.18(44.87,318.86)u/L]、3个月[(2.26±0.21)mmol/L、(1.28±0.25)mmol/L、72.37(64.13,84.40)ng/L、131.98(43.52,199.61)u/L]、6个月[(2.27±0.22)mmol/L、(1.33±0.24)mmol/L、71.11(60.06,83.04)ng/L、104.78(35.36,154.91)u/L]时均低于术前[(2.66±0.15)mmol/L、(2.89±0.70)mmol/L、1277.32(1012.35,1423.85)ng/L、567.68(445.10,741.50)u/L](P<0.05);术后3、6个月时血磷水平均高于术后1个月时(P<0.05),血清ALP水平均低于术后1个月时(P<0.05);术后6个月时血磷水平高于术后3个月时(P<0.05),血清iPTH、ALP水平均低于术后3个月时(P<0.05)。术后6个月时皮肤瘙痒(4.84%)、睡眠障碍(3.23%)发生率及骨痛VAS评分[(1.96±0.91)分]均低于术前[80.65%、69.35%、(5.12±2.29)分](P<0.05)。随访至2020年4月,SHPT复发9例,出现持续性甲状旁腺功能低下5例。结论肾性SHPT患者行TPTX或TPTX+AT可有效缓解临床症状Objective To investigate the changes of serum calcium,serum phosphorus,serum intact parathyroid hormones(iPTH)and alkaline phosphatase(ALP)levels in patients with renal secondary hyperparathyroidism(SHPT)after total parathyroidectomy(TPTX)or total parathyroidectomy with autotransplantation(TPTX+AT),and to investigate the therapeutic effect and safety.Methods Sixty-two patients with renal SHPT underwent TPTX or TPTX+AT.The success rate of surgery and postoperative complications were recorded.The levels of serum calcium,serum phosphorus,serum iPTH and ALP were measured before operation and 1,3 and 6 months after operation.The visual analogue scale(VAS)score of bone pain,and incidences of pruritus and sleep disorders were compared before operation and 6 months after operation.The follow-up survey was done till April,2020,and the postoperative recurrence of SHPT and the incidence of postoperative persistent hypoparathyroidism were recorded.Results Of 62 patients,24 underwent TPTX and 38 underwent TPTX+AT,with the success rate of 100%.The grafts survival rate was 86.8%in patients undergoing TPTX+AT.There were no postoperative complications such as incision infection loss of laryngeal sensory nerves,aphonia or perioperative death.The levels of serum calcium,serum phosphorus,serum iPTH and ALP were lower 1 month after operation[(2.26±0.20)mmol/L,(1.09±0.29)mmol/L,73.74(64.50,86.26)ng/L,223.18(44.87,318.86)u/L],3 months after operation[(2.26±0.21)mmol/L,(1.28±0.25)mmol/L,72.37(64.13,84.40)ng/L,131.98(43.52,199.61)u/L]and 6 months after operation[(2.27±0.22)mmol/L,(1.33±0.24)mmol/L,71.11(60.06,83.04)ng/L,104.78(35.36,154.91)u/L]than those before operation[(2.66±0.15)mmol/L,(2.89±0.70)mmol/L,1277.32(1012.35,1423.85)ng/L,567.68(445.10,741.50)u/L](P<0.05).The level of serum phosphorus was lower 1month after operation than those 3and 6months after operation(P<0.05),and lower 3months after operation than that 6months after operation(P<0.05).The ALP level was lower3and 6months after operation than that 1 month after ope

关 键 词：肾性继发性甲状旁腺功能亢进症 甲状旁腺全切除术 甲状旁腺自体移植术 血钙 血磷 全段甲状旁腺激素 碱性磷酸酶 

分 类 号：R653[医药卫生—外科学]