继发性甲状旁腺功能亢进症患者甲状旁腺全切除联合自体移植术失败的术中影响因素  

Intraoperative influencing factors of failure of total parathyroidectomy plus autotransplantation in patients with secondary hyperparathyroidism

作　　者：张文杰 任海亮 张彤彤 吴剑 ZHANG Wen-jie;REN Hai-liang;ZHANG Tong-tong;WU Jian(Department of General Surgery,the Third People's Hospital of Chengdu,the Affiliated Hospital of Southwest Jiaotong University,Chengdu,Sichuan 610031,China;Center for Gastrointestinal and Minimally Invasive Surgery,the Third People's Hospital of Chengdu,the Affiliated Hospital of Southwest Jiaotong University,Chengdu,Sichuan 610031,China)

机构地区：[1]成都市第三人民医院、西南交通大学附属医院普外科,四川成都610031 [2]成都市第三人民医院、西南交通大学附属医院胃肠微创中心,四川成都610031

出　　处：《中华实用诊断与治疗杂志》2023年第1期33-36,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81502075)。

摘　　要：目的观察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+自体移植术(total parathyroidectomy+autotransplantation,tPTx+AT)的效果,探讨手术失败的术中影响因素。方法102例SHPT患者均行tPTx+AT术,术后随访2~11年,根据随访期间血浆甲状旁腺激素水平分为手术成功组82例和手术失败组20例。比较2组术中甲状旁腺激素(intraoperative parathyroid hormone,ioPHT)检测、颈部探查、切除甲状旁腺数目≥4枚比率等;多因素logistic回归分析SHPT患者行tPTx+AT手术失败的术中影响因素。结果手术失败组行ioPHT检测、颈部探查、切除甲状旁腺数目≥4枚比率(50.00%、20.00%、50.00%)均低于手术成功组(79.27%、45.12%、87.80%)(P<0.05)。切除甲状旁腺后10min ioPTH/麻醉前ioPTH≥20%且行颈部探查患者tPTx+AT手术成功率(84.6%)与切除甲状旁腺后10min ioPTH/麻醉前ioPTH<20%且未行颈部探查者(87.7%)比较差异无统计学意义(χ^(2)=0.395,P=0.530)。行ioPTH检测(OR=4.198,95%CI:1.314~13.411,P=0.015)、切除甲状旁腺数目<4枚(OR=6.944,95%CI:2.117~22.772,P=0.001)是SHPT患者行tPTx+AT术失败的术中影响因素。结论行ioPTH检测、切除甲状旁腺数目<4枚或切除甲状旁腺后10min ioPTH/麻醉前ioPTH≥20%时行颈部探查可有效降低SHPT患者tPTx+AT手术失败风险。Objective To observe the outcome of total parathyroidectomy+autotransplantation(tPTx+AT)in patients with secondary hyperparathyroidism(SHPT),and to investigate the influencing factors of the failure of tPTx+AT.Methods A total of 102SHPT patients underwent tPTx+AT and were followed up for 2to 11years.According to the postoperative parathyroid hormone(PTH)level,102patients were divided into success group(n=82)and failure group(n=20).The percentages of patients receiving intraoperative PTH(ioPTH)detection and neck exploration and with resected parathyroid glands≥4were compared between two groups.Multivariate logistic regression was used to analyze the intraoperative influencing factors of tPTx+AT failure in SHPT patients.Results The percentages of patients receiving ioPTH detection and neck exploration and with resected parathyroid glands≥4were lower in failure group(50.00%,20.00%,50.00%)than those in success group(79.27%,45.12%,87.80%)(P<0.05).The tPTx+AT success rates showed no significant differences between patients with ioPTH 10 min after tPTx/ioPTH before anesthesia≥20%and neck exploration(84.6%)and patients with ioPTH 10 min after tPTx/ioPTH before anesthesia<20%and no neck exploration(87.7%)(χ^(2)=0.395,P=0.530).The ioPTH detection during operation(OR=4.198,95%CI:1.314-13.411,P=0.015)and number of resected parathyroid glands<4(OR=6.944,95%CI:2.117-22.772,P=0.001)were the influencing factors of tPTx+AT failure in SHPT patients.Conclusion The detection of ioPTH during operation,and neck exploration when resected parathyroid glands number<4or ioPTH 10 min after tPTx/ioPTH before anesthesia≥20%can effectively reduce the risk of tPTx+AT failure in patients with SHPT.

关 键 词：继发性甲状旁腺功能亢进症 甲状旁腺全切除+自体移植术 术中甲状旁腺激素检测 

分 类 号：R653[医药卫生—外科学]