全甲状旁腺切除术联合前臂自体移植治疗继发性甲状旁腺功能亢进不同移植量的比较  

Comparative analysis of total parathyroidectomy combined with forearm autotransplantation in the treatment of secondary hyperparathyroidism with different transplant volumes

作　　者：梁玉龙[1] 许润涛 金秋 穆静辉[1] 房轩 翟明宇 郝雨绒 冯文静[1] LIANG Yulong;XU Runtao;JIN qiu(Department of General Surgery,the Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院普通外科,石家庄市050051

出　　处：《河北医药》2023年第14期2168-2171,共4页Hebei Medical Journal

摘　　要：目的研究不同自体移植入路治疗继发性甲状旁腺功能亢进(sHPT)的术后疗效和安全性以及sHPT患者的复发率。方法河北医科大学第三医院(该临床试验注册标识符J2020_006_1)进行开放标签随机对照试验。61例sHPT患者被随机分配接受甲状旁腺全切除术和自体移植。31例患者被分配到A组(移植25 mg),30例患者被分配到B组(移植50 mg)。收集并分析患者术前、术后的临床资料、甲状旁腺激素、钙磷离子水平、骨痛、骨质疏松等症状,分析术后低钙血症的发生率及影响因素、手术成功率及术后复发率。结果2组患者术后第1天、1周、2周、4周的iPTH、血清磷、血清磷积乘积、ALP较术前均明显降低(P<0.05)。2组患者术后第1天、1周、2周、4周血清钙水平均显著升高(P<0.05)。与A组比较,B组患者术后第1天、1周、2周、4周iPTH、ALP值明显降低,血钙明显升高(P<0.05)。尽管术后第1天、1周、2周、4周血清磷均有所下降,但差异无统计学意义(P>0.05)。所有患者的骨痛、皮肤瘙痒等症状均有改善。术后声嘶3例,颈部血肿2例,低钙3例,复发2例。结论对于继发性甲状旁腺功能亢进症患者,50 mg的自体移植似乎优于25 mg的选择,能更好地改善患者的主要临床症状。Objective To analyze the postoperative efficacy and safety of different autologous transplantation approaches in the treatment of secondary hyperparathyroidism(sHPT)and to explore its recurrence rate.Methods It was an open-label randomized controlled trial conducted at the Third Hospital of Hebei Medical University(Registry No.J2020_006_1).A total of 61 sHPT patients were randomly divided into group A(n=31)and group B(n=30).Total parathyroidectomy was performed in all patients,and those in group A and B received 25 mg and 50 mg autotransplantation,respectively.Clinical data,intact parathyroid hormone(iPTH)level,calcium and phosphorus ion levels,bone pain,osteoporosis and other symptoms before and after surgery were analyzed.The incidence of postoperative hypocalcaemia and its influencing factors were analyzed.The success rate of surgery and recurrence rate were calculated.Results The levels of iPTH,serum phosphorus,serum calcium-phosphate product,and alkaline phosphatase(ALP)at 1d,1 week,2 weeks and 4 weeks postoperatively were significantly lower than those of preoperative values(P<0.05).Serum calcium levels at 1d,1 week,2 weeks and 4 weeks postoperatively in both groups were significantly enhanced(P<0.05).Compared with those of group A,iPTH and ALP levels were significantly reduced,and serum calcium was significantly enhanced at 1d,1 week,2 weeks and 4 weeks postoperatively in group B(P<0.05).Serum phosphorus decreased at 1d,1 week,2 weeks and 4 weeks postoperatively in both groups,although no significant differences were detected(P>0.05).Symptoms like bone pain and skin itching were improved in all patients.There were 3 cases of postoperative hoarseness,2 cases of neck hematoma,3 cases of hypocalcemia,and 2 cases of recurrence.Conclusion For patients with secondary hyperparathyroidism,50mg autologous transplantation seems to be better than 25mg,which effectively improves the main clinical symptoms.

关 键 词：甲状旁腺全切除术 自体移植 前臂 继发性甲状旁腺功能亢进 

分 类 号：R458.1[医药卫生—治疗学]