甲状旁腺全切加前臂移植术治疗肾衰继发重症甲状旁腺功能亢进(附九例报告)

Surgery management of severe secondary hyperparathyroidism by parathyroidectomy combined with parathyroid tissue transplantation in forearm(report of 9 cases)

目的 探讨甲状旁腺全切加前臂移植术治疗肾衰继发重症甲状旁腺功能亢进 (SHP)的临床疗效。 方法 回顾性分析 9例患者资料 ,从定位诊断、手术适应证、围手术期处理等方面进行讨论。 结果 9例患者共切除增生甲状旁腺 35枚 ,单人总量 2 .3～ 7.8g ,1例加行左甲状腺切除。移植腺体均成活 ,移植侧上肢PTH与对侧之比 >1.5 ,临床症状改善 ,各项化验结果逐步恢复正常。 结论 对内科治疗无效的肾衰继发重症甲状旁腺功能亢进 ,甲状旁腺全切加前臂移植是一种安全、有效的治疗方法。

Objective To evaluate parathyroidectomy combined with parathyroid tissue transplantation in forearm in the treatment of severe secondary hyperparathyroidism (SHP). Methods 9 cases treated with the procedure were reviewed.The diagnosis,operation indication and peri operative management were discussed. Results Thirty five hypertrophic parathyroids were resected from the 9 cases with SHP,and a left thyroidectomy was carried out for one case.Some parathyroid tissue has been grafted into the forearm for every patient.All of those grafts have survived.The symptoms va nished in all and the relevent laboratory tests recovered to normal after the surgery. Conclusions This surgical strategy is safe and effective for SHP not benefited from medical therapy.