甲状旁腺全切除术加前臂移植治疗尿毒症难治性继发性甲状旁腺功能亢进

Total Parathyroidectomy and Forearm Autograft in the Treatment of Uremia with Refractory Secondary Hyperparathyroidism

【目的】研究甲状旁腺全切除术加自体前臂移植对于尿毒症引起的难治性继发性甲状旁腺功能亢进的效果。【方法】总结分析本院12例因慢性肾脏疾病长期接受规律性血液透析的患者发生继发性甲状旁腺功能亢进（SHPT），因持续性高血钙及高甲状旁腺素（parathyroid hormone，PTH），药物治疗无效，予行甲状旁腺全切除术加前臂移植术的疗效。比较手术前及手术后血PTH值，血钙值以及相关临床症状的变化情况。【结果】手术后12例病患无一例死亡，其中8例血PTH降至正常水平，血钙值一度低于正常水平，经补充钙剂之后恢复正常水平并维持，4例患者术后血PTH及血清钙数值明显降低，但仍高于正常值，故术后再次切除部分移植于前臂的甲状旁腺组织，术后血PTH及血清钙数值均降至正常。全组术后低血钙症发生率达66．7％（8／12）。血清钙术后三周内下降明显，至术后6个月逐渐恢复至正常水平。病患全身骨痛，皮肤瘙痒，乏力，纳差等症状改善明显。骨密度测定，骨量上升明显。【结论】甲状旁腺全切除术加前臂自体移植对于治疗尿毒症难治性继发性甲状旁腺功能亢进症疗效明确，是一种安全可靠的治疗手段。

[Objective]To study the efficacy of total parathyroidectomy combined with forearm autograft for the treatment of refractory secondary hyperparathyroidiam（SHPT） caused by uremia. [Methods]Twelve SHPT patients caused by chronic renal disease receiving long-term regular hemodialysis were analyzed. These patients underwent total parathyroidectomy and forearm autograft due to the failure of drug therapy for persistent hypercalcemia and high parathyroid hormone（PTH）. Serum PTH, calcium and clinical symptoms were compared before and after the operation. [Results] No one in 12 cases died after the operation. Serum PTH in 8 cases dropped to normal level. Serum calcium in these 8 cases even dropped lower than normal level and regained normal level after calcium supplement. After the operation, serum levels of PTH and calcium decreased obviously, but were still higher than normal level in 4 cases. After surgically removing partial parathyroid gland grafted in the forearm again, serum PTH and calcium in 4 cases dropped to normal level. The incidence of postoperative hypoealcemia in all groups was the highest（66.7%, 8/ 12）. Serum calcium decreased obviously 3 week after the operation, and gradually regained normal level 6 months after the operation. Thesymptoms such as bone pain all over the body, skin pruritus, fatigue and inappetence of patients were improved obviously. Bone densitometry showed that bone mass increased obviously. [Conclusion] Total parathyroidectomy and forearm autograft for the treatment of uremia with SHPT has certain efficacy, and is a safe and reliable method.