维持性血液透析患者继发性甲旁亢的手术治疗疗效观察

Therapeutic evaluation of parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients

目的 回顾性总结维持性血液透析患者继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）行甲状旁腺切除术（parathyroidectomy,PTX）的临床疗效.方法 收集2009年10月-2013年11月的25例血液透析患者（平均透析龄58±18.7个月;平均年龄45.6±8.3岁）.监测术后并发症及复发情况.对比分析患者术前及术后1个月、3个月、6个月的临床症状、全段甲状旁腺激素（intact parathyroid hormone,iPTH）、血清钙、血清磷及碱性磷酸酶等变化.结果 25例患者中,甲状旁腺全切术共24例（占96％）,甲状旁腺全切加前臂自体移植术1例（占4％）.术后围手术期无死亡发生.术后绝大部分患者的骨痛及皮肤瘙痒症状在数天内缓解,但随着随访时间的延长,术前颈部彩色超声示小于4枚甲状旁腺结节性增大的5例患者骨痛症状均有复发（20％）,但程度较术前明显减轻.2例患者出现一过性声音嘶哑（发生率8％）.术后全部患者均出现低钙血症（发生率100％）,经积极补钙治疗后均可有效控制.25例患者术前均表现为明显增高的iPTH、血清钙、血清磷和ALP.术后iPTH（P＜0.01）、血清钙（P＜0.01）、血清磷（P＜0.01）和ALP（P＜0.01）水平均较术前显著降低.随访6个月,5例复发（20％）,且均为术前检查小于4枚甲状旁腺结节性增大的患者.结论 PTX治疗维持性血液透析患者继发性甲旁亢是一种相对安全和有效的方法,但其长期疗效仍有待于进一步观察.

Objectives To investigate the clinical effect of parathyroidectomy（PTX） in maintenance hemodialysis patients with secondary hyperparathyroidism（SHPT）.Methods We retrospectively reviewed 25 maintenance hemodialysis patients treated with PTX cases during the period from October,2009 to November,2013 （Their dialysis age ranged 58 ± 18.7 months,and their average age was 45.6 ±8.3 years old）.Their postoperative complications and recurrence were investigated.Their serum intact parathyroid hormone （iPTH）,serum calcium,serum phosphate and alkaline phosphate before and 1 month,3 month,6 month after operation were observed and compared.Results In the 25 PTX cases,24 cases（96%） were treated with total parathyroidectomy,1 cases（4%）were treated with total parathyroidectomy with autotransplantation.No cases died in the perioperative period.Bone pain and pruritus relieved significantly significantly after operation.With the extension of follow-up timeWith the time extending,bone pain was relapsed in 5 patients with parathyroid nodular changes less then than 4 groups on preoperative neck color ultrasound,but the degree was significantly reduced compared with it in the preoperative.time.Temporary injury of recurrent laryngeal nerve was found in 2 cases （8%）.Postoperative hypocalcemia was occurred in all patients （100%）,but active treatment was eEffective.The preoperative serum iPTH,serum calcium,serum phosphorus and alkaline phosphatase abnormally elevated in all patients before operation.The postoperative iPTH （P 〈 0.001）,serum phosphorus（P 〈0.001） serum calcium（P 〈0.001） and serum ALP（P 〈0.001） lowered significantly than those at preoperative period.In the 25 patients followed up after operation for more than six months,recurrent hyperparathyroidism was found in 5 patients,all of them had nodular changes less then than 4 groups.Conclusions PTX is a relatively safe and effective method in the treatment of MHD patients with SHPT.But its long-term efficacy remains to be confirmed.