甲状旁腺次全切除术治疗肾衰继发甲状旁腺功能亢进(附37例)

Subtotal parathyroidectomy for uremic patients with secondary hyperparathyroidism:a review of 37 cases

目的探讨甲状旁腺次全切除术治疗继发性甲状旁腺功能亢进的临床疗效。方法回顾性分析我院2008-03～2009-09收治的37例肾衰继发甲状旁腺功能亢进患者的资料,患者均行甲状旁腺次全切除术,观察围手术期血甲状旁腺素、血钙磷变化情况及临床症状的改善情况。结果次全切除术后患者骨痛、全身瘙痒症状明显缓解,血甲状旁腺素、血磷较术前明显下降。37例患者中手术成功30例,手术切除不足7例,两组间切除术后10min血甲状旁腺素下降程度无显著性差异(P=0.32)。15例随访半年以上的手术成功患者无复发。1例出现钙化防御的患者成功手术后3月死亡。结论对难治性、有症状的继发性甲状旁腺功能亢进患者应及时手术治疗,甲状旁腺次全切除术是有效的治疗方法。

Objective To explore the clinical efficacy of subtotal parathyroidectomy for secondary hyperparathyroidism. Methods Thirty-seven uremic patients with secondary hyperparathyroidism were analyzed retrospecfvely. All patients underwent subtotal parathy- roidectomy. Perioperative symptom improvement and changes of serum iPTH, calcium, phosphate and alkaline phosphatase were ob- served. Results After operation, bone pain and pyruitus were relived, and serum intact parathyroid hormone （iPTH）and serum phos- phate were declined markedly. Of 37 cases ,30 had successful operation, and 7 had persistent hyperparathyroidism. No statistic difference was found in the decline of serum iPTH 10 min after operation between the successful and persistent cases. Of 30 cases of successful subtotal parathyroidectomy, 15 had no recurrence after followed-up for 6 months. One case of calciphylaxis died at month 3 after suc- cessful subtotal parathyroidectomy. Conclusion Subtotal parathyroidectomy may be a good option for treating patients with symptomatic or refractory secondary hyperparathyroidism.