尿毒症继发性甲旁亢甲状旁腺切除术临床观察

Clinical observation of parathyroidectomy in uremic patients with secondary hyperparathyroidism

目的探讨尿毒症继发性甲状旁腺功能亢进症(继发性甲旁亢)的临床特征、发病机制及甲状旁腺切除术的治疗意义。方法回顾性总结3例尿毒症继发性甲旁亢患者甲状旁腺切除术前、术后的临床表现、实验室及影像学检查、病理活检结果,结合文献分析其发病机制及手术的治疗意义。结果3例患者存在不同程度的肌肉骨骼皮肤症状、转移性钙化,血清Ca、P、PTH升高,X线下骨病变,彩超及病理活检甲状旁腺结节状增生或腺瘤形成,术后明显好转。结论尿毒症继发性甲旁亢引起多系统损害,甲状旁腺切除术是治疗药物无效甲旁亢的有效方法。

Objective To investigate the clinical feature,pathogenesis of secondary hyper-parathyroidism（SHPF） and parathyroidectomy in uremic patients. Methods Three patients undergone parathyroidectomy due to uremic SHPT were reported retrospectively：preoperative and postoperative clinical manifestations, results of lab testing,imaging and pathologic biopsy. To discuss the pathogenesis and surgical treatment with literature. Results Three patients had different levels of musculoskeletal, skin malaise and ectopic calcification. Serum calcium,phosphorus and PTH concentration increased. Different skeletal disorders were seen with X-ray. Nodular hyperplasia or adenoma of parathyroid were found in color uhrasonograph and pathologic biopsy. Most of these lesions improved after surgery. Conclusion Uremic SHPT may cause multiple-system lesions. Parathyroidectomy should be chosen when medical treatment is invalid.