甲状旁腺全切除联合小腿皮下自体移植术治疗继发性甲状旁腺功能亢进症的临床应用价值  

Clinical value of total parathyroidectomy combined with calf subcutaneous autotransplantation in the treatment of secondary hyperparathyroidism

作　　者：李咏恬 赵沨 王文平[1] 程丹清 王益松 王儒娟 田崇越 LI Yongtian;ZHAO Feng;WANG Wenping;CHEND Danqing;WANG Yisong;WANG Rujuan;TIAN Chongyue(Department of Thyroid and Breast Surgery,The First Hospital of Anhui University of Science&Technology,Huainan 232000,China)

机构地区：[1]安徽理工大学第一附属医院甲乳外科,安徽淮南232000

出　　处：《沈阳医学院学报》2025年第1期38-42,共5页Journal of Shenyang Medical College

基　　金：安徽省高等学校科学研究项目(自然科学类)重大项目(No.2023AH040405)。

摘　　要：目的:探讨甲状旁腺全切除联合小腿皮下自体移植术治疗继发性甲状旁腺功能亢进症的手术疗效。方法:选取2018年12月至2022年12月在我院接受甲状旁腺全切除联合小腿皮下自体移植术的继发性甲状旁腺功能亢进症患者31例,分析其治疗效果。结果:31例手术均圆满完成,手术中共切除甲状旁腺120枚,其中切除4颗甲状旁腺的有27例(87.10%),切除3颗甲状旁腺的有4例(12.90%)。平均住院天数(15.82±8.74) d。与术前甲状旁腺激素比较,甲状旁腺全切20 min后数值下降50%以上;术后各时点血钙、磷、iPTH及钙磷乘积水平与术前比较,均明显下降(P<0.01)。术后所有患者关节疼痛症状明显改善。31例患者术后随访中1例患者术后6个月证实为移植物复发予以手术切除。结论:甲状旁腺全切除联合小腿皮下自体移植术可有效治疗继发性甲状旁腺功能亢进症,显著改善患者生活质量。Objective:To investigate the surgical effect of total parathyroidectomy combined with calf subcutaneous autotransplantation in the treatment of secondary hyperparathyroidism.Method:From Dec 2018 to Dec 2022,31 patients with secondary hyperparathyroidism who underwent total parathyroidectomy combined with calf subcutaneous autotransplantation in our hospital were selected to analyze the therapeutic effect.Results:All 31 operations were successfully completed.A total of 120 parathyroid glands were removed,including 27 cases(87.10%)with 4 parathyroid glands and 4 cases(12.90%)with 3 parathyroid glands.The average length of hospitalization was(15.82±8.74)days.Compared with preoperative parathyroid hormone,the value of parathyroid hormone decreased by more than 50%after 20 min of total parathyroidectomy.The levels of serum calcium,phosphorus,iPTH and calcium-phosphorus product at each time point after operation were significantly lower than those before operation(P<0.01).The symptoms of joint pain was significantly improved in all patients after operation.During the postoperative follow-up of 31 patients,1 patient was confirmed to have graft recurrence at 6 months after operation,which was surgically removed.Conclusion:Total parathyroidectomy combined with calf subcutaneous autotransplantation can effectively treat secondary hyperparathyroidism and significantly improve the quality of life.

关 键 词：甲状旁腺自体移植 小腿移植 皮下移植 继发性甲状旁腺功能亢进症 甲状旁腺全切除 

分 类 号：R653[医药卫生—外科学]