超声引导下激光消融术治疗难治性继发性甲状旁腺功能亢进的近期疗效  

Short-Term Efficacy of Ultrasound-Guided Laser Ablation in Treatment of Refractory Secondary Hyperparathyroidism

作　　者：廖琳[1] 施倩[2] 孙永康[2] 胡静[1] 陈杰[1] 张传富[1] 刘文瑞[1] 路建饶[1] LIAO Lin;SHI Qian;SUN Yongkang;HU Jing;CHEN Jie;ZHANG Chuanfu;LIU Wenrui;LU Jianrao(Department of Nephrology,The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China;Department of Ultrasound,The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]上海中医药大学附属第七人民医院肾病科,上海市200137 [2]上海中医药大学附属第七人民医院超声科,上海市200137

出　　处：《中国激光医学杂志》2022年第4期207-212,238-240,共9页Chinese Journal of Laser Medicine & Surgery

基　　金：上海市浦东新区卫生健康委员会卫生计生科研项目(PW2019A-19);上海市第七人民医院人才培养计划项目(QMX2019-02)。

摘　　要：目的探析超声引导下激光消融术(laser ablation,LA)治疗难治性继发性甲状腺旁功能亢进(secondary hyperparathyroidism,SHPT)的近期疗效和对血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)、Ⅰ型胶原羧基端肽β特殊序列(βC-terminal telopeptide of type I collagen,β-CTX)、总Ⅰ型胶原氨基端延长肽(total procollagen type I N-propeptide,TP1NP)水平的影响。方法选择2019年1月至2020年12月,难治性SHPT患者60例,按照随机数表法分为LA组和甲状旁腺切除术(parathyroidectomy,PTX)组,每组患者各30例。其中,LA组采用激光消融术,激光单点最低能量50 J,单点最高能量1000 J;PTX组采用传统手术治疗。记录两组患者手术时间、住院时间。分别于术前、术后1周、1个月、3个月、6个月,利用视觉模拟评分法(visual analogue scale,VAS)对患者的主要症状进行评估。并分别于术前、术后1 d、1周、1个月、3个月、6个月,测定两组患者血清全段iPTH、β-CTX、TP1NP、钙(Ca)及磷(P)浓度。同时,观察两组神经损伤、低钙血症等并发症发生情况。结果治疗后两组患者主要症状VAS评分与治疗前比较均明显下降,其中PTX组术后1周和1个月,皮肤瘙痒、骨痛评分较LA组下降更明显(P<0.05)。术后各时间点,两组患者血清iPTH、TP1NP、β-CTX、Ca、P水平均较术前明显降低;与术前相比,PTX组术后1 d、1周血清Ca、P、iPTH、TP1NP的下降幅度较LA组更明显(P<0.05)。LA组手术时间、住院时间和术后低钙血症发生率明显少于PTX组,差异均具有统计学意义(P<0.05)。结论超声引导下LA治疗SHPT短期疗效与PTX相当,均能有效改善患者的临床症状和有关实验室指标,但LA住院时间更短,术后并发症更少,其长期疗效有待进一步观察。Objective To analyze the effect of ultrasound-guided laser ablation(LA)on serum intact parathyroid hormone(iPTH),Beta Cterminal cross-linked telopeptides of typeⅠcollagen(β-CTX)and total procollagen type 1 amino-terminal peptide(TP1NP)levels in the treatment of secondary hyperparathyroidism(SHPT).Methods A total of 60 SHPT patients admitted from Jan.2019 to Dec.2020 were divided randomly into the LA group and parathyroidectomy(PTX)group.The main symptoms of patients in the two groups were evaluated with visual analogue scale(VAS)before the surgery,1 week and 1,3 and 6 months after the surgery.The levels of serum iPTH,β-CTX,TP1 NP,calcium(Ca)and phosphorus(P)of the patients in the two groups were measured respectively before the surgery,1 day,1 week and 1,3 and 6 months after the surgery.The operation time,hospitalization time,nerve injury,hypocalcemia and other complications of patients in the two groups were recorded.Results Compared with those before the operation,the VAS scores of main symptoms in the two groups were much lower at all time points after the operation.The scores of skin pruritus and bone pain in the PTX group decreased more significantly than those in the LA group 1 week and 1 month after the operation(P<0.05).The levels of serum iPTH,TP1 NP,β-CTX,Ca and P at all time points after the operation were significantly lower than those before the operation.The levels of serum iPTH,TP1 NP,Ca and P in the PTX group were significantly lower than those in the LA group 1 day and 1 week after the operation(P<0.05).The operation time and hospital stay in the LA group were significantly shorter than those in PTX group(P<0.05),and the incidence of postoperative hypocalcemia of the former was lower(P<0.05).Conclusions The short-term efficacy of ultrasound-guided LA in treating SHPT is equivalent to that of PTX,including effectively improving the clinical symptoms and relevant laboratory indexes of patients.However,LA boasts shorter hospital stay and fewer postoperative complications,and its long-term effic

关 键 词：超声 激光消融术 继发性甲状旁腺功能亢进 骨代谢 

分 类 号：R616.4[医药卫生—外科学] R582[医药卫生—临床医学]