不同病理形态的自体移植物在甲状旁腺全切除加自体移植术后的效果评价  

Autograft function by pathological types after total parathyroidectomy in patients of hyperthyroidism

作　　者：李浩[1] 李华玉 方静怡[2] 孙少华[1] 沈丰[1] 方大正[1] Li Hao;Li Huayu;Fang Jingyi;Sun Shaohua;Shen Feng;Fang Dazheng(Thyroid Center,Sinopharm Dongfeng General Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,China;Department of Pathology,Sinopharm Dongfeng General Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,China)

机构地区：[1]湖北医药学院附属国药东风总医院甲状腺诊疗中心,十堰442000 [2]湖北医药学院附属国药东风总医院病理科,十堰442000

出　　处：《中华普通外科杂志》2024年第5期367-371,共5页Chinese Journal of General Surgery

基　　金：湖北省卫健委项目(WJ2021F052)。

摘　　要：目的研究不同病理形态的自体移植物在甲状旁腺全切除+自体移植术后的效果。方法选取2017年3月至2021年2月期间在湖北医药学院附属国药东风总医院接受甲状旁腺全切除+自体前臂移植术共51例慢性肾功能衰竭终末期患者,根据移植物细胞类型分为主细胞增生组(CC组)和嗜酸细胞增生组(OC组),观察两组患者围手术期至术后6个月内血清甲状旁腺素、钙、磷、碱性磷酸酶水平及术后6个月时三维超声体积,以综合判定不同细胞类型移植的效果。结果两组患者在术后30 min、1个月时血清甲状旁腺激素、钙、磷、碱性磷酸酶水平差异均无统计学意义(均P>0.05)。术后3个月血清碱性磷酸酶水平差异无统计学意义[CC组:(99±23)U/L,OC组:(89±35)U/L,t=0.776,P=0.442]。术后6个月CC组与OC组血清甲状旁腺激素[CC组:(290±77)pg/ml,OC组:(246±59)pg/ml,t=2.034,P=0.047]、血钙[CC组:(2.62±0.65)mmol/L,OC组:(2.21±0.20)mmol/L,t=2.531,P=0.015]、血磷[CC组:(1.38±0.28)mmol/L,OC组:(1.68±0.34)mmol/L,t=-3.269,P=0.002]相比差异均有统计学意义。术后6个月CC组移植处甲状旁腺三维超声体积大于OC组,差异有统计学意义[CC组:(2.17±0.37)cm 3,OC组:(1.85±0.29)cm 3,t=3.172,P<0.05]。两组术后1年复发病例数差异无统计学意义(CC组3例,OC组1例,t=0.277,P>0.05)。结论CC组移植物的生物学活性较OC组高,应引起重视。Objective To evaluate alteration of autograft function by pathological types after total parathyroidectomy(tPTX)plus autotransplantation(AT)in patients of hyperthyroidism.Methods A total of 51 patients with end-stage chronic renal failure who underwent total parathyroidectomy with autologous forearm transplantation from Mar 2017 to Feb 2021 were divided into chief cell type(CC)and oxyphil cell type(OC)according to dominating graft cell type.iPTH,calcium,phosphorus and ALP levels were compared between the two groups from the perioperative period to 6 months and the 3D ultrasonography was performed at 6 months to cocalculate the size of the autograft.Results Between the two groups,there were no statistically significant differences in iPTH,blood calcium,blood phosphorus,or ALP levels pre-,and 30 minutes,one month post surgery(all P>0.05).On three months,there was no significant difference in ALP levels[CC group:(99±23)U/L,OC group:(89±35)U/L,t=0.776,P=0.442].At 6 months the PTH level[CC group:(290±77)pg/ml,OC group:(246±59)pg/ml,t=2.034,P=0.047],and blood calcium[CC group:(2.62±0.65)mmol/L,OC group:(2.21±0.20)mmol/L,t=2.531,P=0.015]blood phosphorus[CC group:(1.38±0.28)mmol/L,OC group:(1.68±0.34)mmol/L;t=-3.269,P=0.002],were all in favor of CC group.By 3D ultrasnography at 6 months the size of autograft was larger in CC group than in OC group[V cc=(2.17±0.37)cm 3,V oc=(1.85±0.29)cm 3,t=3.172,P<0.05].Recurrences at 1 year after surgery were not significantly different between the two groups(n cc=3,n oc=1,t=0.277,P>0.05).Conclusion The biological activity of CC-type grafts is higher than that of OC suggesting a longer functioning period as a parathyroid autograft.

关 键 词：甲状旁腺功能亢进症 继发性 移植物 肾功能衰竭 慢性 甲状旁腺切除术 

分 类 号：R653[医药卫生—外科学]