甲状旁腺全切术与甲状旁腺全切术+微量自体移植术治疗继发性甲状旁腺功能亢进的疗效对照  

Efficacy of total parathyroidectomy and total parathyroidectomy with autotransplantation in treatment of secondary hyperparathyroidism

作　　者：郭浩男 周鹏 李小磊 岳涛 徐婧 邵长秀 贺青卿 庄大勇 GUO Haonan;ZHOU Peng;LI Xiaolei;YUE Tao;XU Jing;SHAO Changxiu;HE Qingqing;ZHUANG Dayong(Postgraduate Training Base of 960th Hospital of PLA Joint Logistics Support Force of Jinzhou Medical University,Jinan 250031,Shandong,China;Department of Thyroid and Breast Surgery,The 960th Hospital of PLA Joint Logistics Support Force,Jinan 250031,Shandong,China)

机构地区：[1]锦州医科大学中国人民解放军联勤保障部队第九六〇医院研究生培养基地,山东济南250031 [2]中国人民解放军联勤保障部队第九六〇医院甲状腺乳腺外科,山东济南250031

出　　处：《山东大学学报(医学版)》2024年第12期72-81,89,共11页Journal of Shandong University:Health Sciences

基　　金：中国人民解放军联勤保障部队医学重点学科项目。

摘　　要：目的探讨手术治疗继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的更优术式,为临床治疗提供循证依据,进一步提高患者生存质量,改善预后。方法回顾性分析2021年12月至2023年2月就诊于中国人民解放军联勤保障部队第九六〇医院甲状腺乳腺外科75例SHPT患者的临床资料,根据病情分为甲状旁腺全切术(total parathyroidectomy,TPTX)组(n=35)和甲状旁腺全切术+微量自体移植术(total parathyroidectomy with autotransplantation,tPTX+AT)组(n=40)。分析患者术前及术后1 d,1、3、6个月,1年的甲状旁腺激素、血清钙、血清磷的变化,并对两组患者住院期间静脉补钙时间、补钙量(葡萄糖酸钙量)、围术期并发症和复发情况进行评估。比较患者术前及术后6个月、1年的骨形成标志Ⅰ型胶原氨基端前肽和骨吸收标志Ⅰ型胶原羧基端肽、脊柱骨密度及左股骨颈骨密度T值评分。采集患者术前及术后6个月、1年的健康调查简表(the MOS 36-item short-form health survey,SF-36)进行分析,评估患者生活质量。结果两组基线资料差异无统计学意义(P>0.05)。两组切除甲状旁腺数量、合并甲状腺手术情况差异无统计学意义(P>0.05)。住院期间补钙时间和补钙量差异无统计学意义(P>0.05)。两组复发性甲状旁腺功能亢进(recurrent hyperparathyroidism,RHPT)的发生率和术后1年低钙血症的发生率差异均无统计学意义(P>0.05)。永久性甲状旁腺功能减退发生率两组差异有统计学意义(P<0.01)。两组术后1 d,1、3、6个月,1年的血钙、血磷和甲状旁腺激素水平均较术前显著下降(P<0.05);术后1个月血钙值最低,术后3个月逐渐升高,术后1年趋于稳定基本接近正常值;TPTX组甲状旁腺激素术后骤降,术后1 d至术后1年无明显变化;tPTX+AT组甲状旁腺激素同样为术后先骤降,术后1d至术后1个月无明显变化,术后3个月较术后1个月升高差异有统计学意义(P<0.05),术�Objective To explore a better surgical treatment for secondary hyperparathyroidism(SHPT),so as to provide evidence-based basis for clinical treatment,and further improve the quality of life and prognosis of patients.Methods The clinical data of 75 patients with SHPT admitted to the Department of Thyroid and Breast Surgery,the 960th Hospital of PLA Joint Logistics Support Force from December 2021 to February 2023 were retrospectively analyzed.According to the condition,the patients were divided into total parathyroidectomy(TPTX)group(n=35)and total parathyroidectomy with autotransplantation(tPTX+AT)group(n=40).The changes of parathyroid hormone,serum calcium and serum phosphorus were monitored before operation and 1 day,1 month,3 months,6 months and 1 year after operation.The time and amount of intravenous calcium supplement(calcium gluconate)during hospitalization,perioperative complications and recurrence were evaluated and analyzed in the two groups.Meanwhile,before and after operation(6 months,1 year)bone formation markers,i.e.N-terminal propeptide of typeⅠcollagen,bone resorption markers,i.e.βcross-linked C-telopeptide of type I collagen,spinal bone mineral density and bone mineral density of the left femoral neck T value scores were compared.The MOS 36-item short-form health survey(SF-36)was used to evaluate the quality of life of patients before and after operation(6 months,1 year).Results There was no significant difference in baseline data between the two groups(P>0.05).There was no statistically significant difference in the number of parathyroid glands removed and the situation of combined thyroid surgery between the two groups(P>0.05).There was no statistically significant difference in calcium supplementation time and amount during hospitalization between the two groups(P>0.05).There was no statistically significant difference in the incidence of recurrent hyperparathyroidism(RHPT)and the incidence of hypocalcemia 1 year after surgery between the two groups(P>0.05).There was a statistically signifi

关 键 词：继发性甲状旁腺功能亢进症 甲状旁腺切除术 骨转换标志物 骨密度 生存质量 

分 类 号：R736.2[医药卫生—肿瘤]