甲状旁腺全切除加自体前臂移植术治疗尿毒症继发性甲状旁腺功能亢进症的疗效分析  被引量:3

Analysis of efficacy of total parathyroidectomy combined with autologous forearm transplantation for uremic secondary to hyperparathyroidism

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作  者:曹素娟 刘书政 袁步奇 袁培乐 赵松鹤 Cao Sujuan;Liu Shuzheng;Yuan Buqi;Yuan Peile;Zhao Songhe(Huadu District People’s Hospital,Southern Medical University,Guangzhou 510317,China)

机构地区:[1]南方医科大学附属花都医院,广东广州510317

出  处:《海军医学杂志》2022年第6期616-620,共5页Journal of Navy Medicine

基  金:广州市科学技术局基础与应用基础研究项目(202002030285)。

摘  要:目的回顾总结甲状旁腺全切除加自体前臂移植术(total parathyoidectomy with autoteansplantation,tPTX+AT)对治疗尿毒症继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的短期和远期疗效。方法收集2016年10月至2018年4月在南方医科大学附属花都医院行tPTX+AT的28例尿毒症透析患者的临床资料。28例患者平均年龄50岁,平均透析龄72个月,其中血透18例,腹透7例,腹透改血透3例。对比患者术前、术后以及随访期间的全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙、血磷水平,以及术后并发症、复发情况。术后患者随访时间最长者为18个月,故以6个月为界分为短期疗效和远期疗效。结果28例中无手术死亡病例,无切口感染、出血情况;2例出现一过性声音低钝,经保守治疗后恢复正常;以手术后iPTH下降水平大于术前50%为手术成功标准,28例中失败1例,其余27例术后iPTH、血磷水平明显下降(P<0.05),成功率96.4%(27/28)。手术成功后iPTH水平再次升高>600 pg/ml且伴有骨痛、皮肤瘙痒等症状被定义为复发。共2例(2/27)复发,复发率7.4%;其中短期随访(6个月以内)中1例复发,20例远期随访(6~18个月,中位数12个月)中,1例复发,其余19例未见复发;术后iPTH较手术前明显下降(P<0.05)。结论甲状旁腺全切除加自体前臂移植术治疗尿毒症继发甲性状旁腺功能亢进症是一种安全、有效的手术方法,其短期疗效和远期疗效可靠,可明显提高患者生活质量和改善代谢紊乱症状。Objective To review the short⁃term and long⁃term effects of total parathyoidectomy with autologous forearm trans⁃plantation(tPTX+AT)in treatment of uremic secondary hyperparathyroidism(SHPT).Methods The clinical data of 28 uremic dialy⁃sis patients who underwent tPTX+AT in the hospital from October 2016 to April 2018 were enrolled for study.The average age of the patients were 50 years,with an average length of dialysis of 72 months.Of the 28 patients,18 underwent hemodialysis,7 underwent peritoneal dialysis and 3 cases switched from peritoneal dialysis to hemodialysis.The results of intact parathyroid hormone(iPTH),se⁃rum calcium and blood phosphorus before and after surgery,as well as during the medical follow⁃ups were compared.In addition,postoperative complications and recurrence were also compared and analyzed.The longest follow⁃up time of the patient was 18 months.With 6 months as a boundary,the treatment effects were divided into the short⁃term efficacy and the long⁃term efficacy.Re⁃sults There were no death cases in 28 cases,no cases of incision infection and serious hemorrhage.There were 2 cases with tran⁃sient blunt voice,and after conservative treatment,they all returned to normal.With the decrease of iPTH after surgery being 50%greater than that before surgery as the success criterion,there was only one case of failure.The levels of iPTH and blood phosphorus in the remaining 27 cases all decreased significantly(P<0.05),with the success rate of 96.4%(27/28).Reversed iPTH level after sur⁃gery(>600 pg/ml)accompanied by bone pain and skin itch could be defined as recurrence.During the short⁃term medical follow⁃up(within 6 months),there were 2 cases of recurrence(2/27),with a recurrence rate of 7.4%.In the 20 cases who had long⁃term follow⁃up(6⁃18 months,with 12 monhs as a medium),there was only one case of recurrence and no recurrence was found in the remaining 19 cases.The level of iPTH after surgery significantly decreased as compared with that before surgery(P<0.05).Co

关 键 词:甲状旁腺切除术 甲状旁腺功能亢进 尿毒症 

分 类 号:R653[医药卫生—外科学]

 

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