甲状旁腺全切除加上臂移植术治疗尿毒症继发性甲状旁腺功能亢进

Total parathyroidectomy and upper arm autograft in the treatment of uremic secondary hyperparathyroidism

目的 研究尿毒症患者因继发性甲状旁腺功能亢进（SHPT）行甲状旁腺全切除加自体上臂移植术（TPTX＋AT）的临床疗效.方法 回顾分析我院30例因慢性肾脏病长期接受规律性透析的患者发生难治性SPTH,予行甲状旁腺全切除加自体上臂移植术,比较患者术前、术后全段甲状旁腺激素（iPTH）、血清钙、磷及碱性磷酸酶（ALP）、血红蛋白（Hb）的变化情况、临床症状改善情况,从而判断疗效.结果 30例患者中,无一例死亡;2例患者发生喉返神经损伤,发生率为6.67％.术后低钙发生率高（79.5％,25/30）,均经积极静脉补钙后有效控制.患者术后各时间点（1天、1周、1、3、6个月）血iPTH、血清磷、血清钙均较术前显著下降（P＜0.01）.术后3、6个月血清ALP较术前显著下降（P＜0.01）,而Hb较术前明显升高（P＜0.05）.术后患者骨痛、皮肤瘙痒、肌无力、失眠、不宁腿、贫血等得到明显改善,全身营养状态好转.结论 甲状旁腺全切除加自体上臂移植术能安全、有效治疗尿毒症难治性SHPT.

Objective To study the clinical effect of total parathroidectomy combined with upper arm autograft （TPTX ＋ AT） in the treatment of uremic patients with secondary hyperparathyroidism （SHPT）. Methods 30 refractory SHPT patients caused by long-term regular dialysis because of chronic renal disease underwent TPTX ＋ AT. Determined the clinical efficacy by comparing the levels of intact parathyroid hormone （iPTH）, serum calcium, serum phosphate, alkaline phosphatase （ALP）, hemoglobin （Hb） and clinical symptoms before and after operation. Results No one in 30 cases died after operation. Recurrent laryngeal nerve injury was found in 2 cases （6.6%）, postoperative hypocalcemia in 25 cases （79.5%）, effectively controlled by intravenous calcium. The levels of iPTH, serum phosphorus, serum calcium 1 day, 1 week, 1 month, 3 months and 6 months after operation significantly lowered than those before operation（P 〈 0.01）. The level of ALP 3, 6 months after operation significantly lowered than those before operation （P 〈 0.01）, the level of Hb rose（P 〈 0.05）. Bone pain, itching, myasthenia, insomnia, restless legs syndrome, anemia and nutritional status significantly improved. Conclusion TPTX ＋ AT is a safe and effective treatment method for uremic patients with refractory SHPT.