70例尿毒症继发性甲状旁腺亢进症行甲状旁腺全切术的疗效分析

Therapeutic effect of parathyroidectomy for 70 uremic patients with secondary hyperparathyroidism

目的 探讨甲状旁腺全切术（T-PTX）治疗尿毒症继发性甲状旁腺亢进（SHPT）的疗效.方法 回顾性分析2007年7月～2013月4月在武警总医院肾内科接受T-PTX术的70例慢性肾衰竭SHPT患者的临床资料,分析手术前后及随访6个月期间血甲状旁腺激素（PTH）、血钙（Ca）、血磷（P）、血碱性磷酸酶（ALP）的变化,以及患者皮肤瘙痒、骨痛等症状的改善情况.结果 ①70例患者手术成功67例,成功率为95.7％;②术后临床症状改善情况：全部患者骨痛症状消失,全身瘙痒症状得到明显缓解,肌无力、失眠、纳差症状也迅速改善,全身营养状况好转,10例术前不能行走靠轮椅代步的患者在1年内改善为自由行走;③术后1周、1月、6月复查血PTH、P、ALP均较术前相比明显下降（P＜0.05）;④术后出现声音嘶哑症状2例,发生率为2.85％,均在1周内自行缓解;术后发生低钙血症59例,发生率84.3％,均经静脉补钙后得到缓解;⑤全部患者随访6个月,65例病情稳定,血PTH及钙磷维持在正常范围;2例患者复发,复发率为2.9％,其中1例复发患者经再次手术治疗后,PTH降至15.0pg/ml.结论 T-PTX可有效降低患者血PTH水平,改善临床症状,是治疗SHPT安全有效的方法,长期随访未见明显并发症.

Objective To retrospectively analyze the therapeutic effect of total parathyroidectomy （TPTX） on uremic patients with secondary hyperparathyroidism （SHPT）.Methods Seventy SHPT patients treated with T-PTX in our hospital were enrolled in this study.Serum parathyroid hormone （PTH）,calcium （Ca）,phosphorus （P） and alkaline phosphatase （ALP） obtained in the preoperative,postoperative and followup periods were collected and compared.Their symptoms,postoperative complications and relapse were recorded.Results ①T-PTX operation performed successfully in 67/70 patients （95.7％）.①After T-PTX,bone pain,itching,weakness,insonnia and anorexia improved rapidly,with the improvement of nutritional status.Ten cases can walk freely without wheelchair within one year after T-PTX.③Serum PTH,Ca,P,and ALP decreased significantly after PTX for one week,one month and 6 months as compared with those before PTX （P＜0.05）.④ Hoarseness was found in 2 cases （2.85％） in postoperative period,and improved spontaneously within one week.Postoperative hypocalcemia was frequently seen （59/70,84.3％） but could be effectively controlled by intravenous calcium infusion.⑤SHPT recurred in the 6 months after T-PTX in 2 cases （2.9％）.One of them accepted PTX again,and PTH decreased to 15.0 pg/ml after the operation.Conclusion T-PTX can effectively decrease PTH level and improve symptoms,and is a safe measure for the treatment of uremic patients with SHPT.