继发性甲状旁腺功能亢进的外科治疗

Surgical management of the secondary hyperparathyroidism

目的探讨甲状旁腺全切除术治疗慢性肾功能衰竭继发甲状旁腺功能亢进（SHPT）的临床疗效。方法回顾性分析12例接受甲状旁腺全切除术的临床资料，比较其临床症状及体征、血钙、磷、碱性磷酸酶（AKP）、全段甲状旁腺激素（iPTH）、红细胞压积（HCT）、甘油三酯（TG）等指标在手术前后的变化及术后并发症的情况。结果12例术后临床症状及体征明显改善，血钙、磷、AKP、iPTH、HCT均较术前下降，差异有统计学意义（P〈0．05）；TG与术前比，差异无统计学意义（P〉0．05）；本组术后均有不同程度的低血钙发生，1例术后持续性高iPTH，1例术后复发，无喉返神经的损伤。结论严重的肾性甲状旁腺功能亢进症经内科治疗无效者，应及时行甲状旁腺全切除术，可明显改善患者生活质量。

Objective To study the clinical effect of total parathyroidectomy on the patient with secondary hyperparathyroidism related to chronic renal failure. Methods The clinical data of 12 cases of total parathyroidectomy were retrospectively analyzed. All changes between preoperation and postoperation were compared, that included the clinical presentations, serum calcium and phosphate, plasma alkaline phosphatase （AKP） , parathyroid hormone （ iPTH）, blood haematocrit （ HCT）, blood-lipid （TG） and complications. Results The clinical symptoms and signs were markedly improved in all cases. A postoperative decrease in the laboratory indexes of serum calcium and phosphate, AKP, iPTH, HCT was also observed（P 〈0. 05）. But the difference of TG did not reach statistical significance （ P 〉 0. 05 ）. Hypocalcaemia occurred in all patierts in different degrees. Plasma iPTH maintained at high level in 1 case and recurrence happened in 1 case after operation. Conclusions Total parathyroidectomy is an effective treatment for severe uremic secondary hyperparathyroidism and can improve the patient＇s life quality.