甲状旁腺全切并自体前臂移植术对难治性继发性甲状旁腺功能亢进患者骨代谢的影响

Effect of total parathyroidectomy with autotransplantation on bone metabolism in patients with severe secondary hyperparathyroidism

目的探讨甲状旁腺全切并自体前臂移植术(PTX+AT)对难治性继发性甲状旁腺功能亢进(SHPT)患者骨代谢的影响。方法分析终末期肾病合并SHPT,成功行PTX+AT并能按照要求定期随访6个月的患者30例,收集患者术前和术后1、3及6个月血清钙、磷、全段甲状旁腺激素(i PTH)及碱性磷酸酶,测量患者术前和术后6个月头颅额部兴趣区CT值,统计并分析结果。结果 1 30例患者全部成功手术,术后骨痛、皮肤瘙痒、不宁腿症状均缓解,未再出现新发骨折和异位钙化;2术后血钙、磷及i PTH较术前降低,差异有统计学意义(P<0.01),术后半年头颅兴趣区CT值较术前升高,差异有统计学意义(P<0.05);3术后低钙血症发生率较高,达76.7%(23/30),积极静脉、口服补钙后19例纠正;2例发生一过性声音嘶哑,随访3个月内恢复;随访半年内,无复发病例。结论 PTX+AT是治疗SHPT的一种安全有效手段,可以纠正钙磷代谢紊乱,改善患者骨代谢,增加骨量,降低骨折发生率。

Objective To observe the effect of total parathyroidectomy with autotransplantation （ PTX ＋AT ） on bone metabolism in patients with severe secondary hyperparathyroidism （ SHPT） . Methods 30 patients who un-derwent PTX＋AT for ESRD and SHPT were followed-up over a 6-month period in this study. Blood parameters consisting of calcium, phosphorus, intact parathyroid hormone （ iPTH） , alkaline phosphatase （ ALP） were collect-ed at different time before and after surgery（1, 3, 6 months）. Concomitantly, the interest region CT value of crani-al frontal was measured before and after surgery（6 months） . All patients signed informed consent. Results ①Of all the 30 cases undergone PTX＋AT, bone pain, itching and restless legs symptom were greatly improved in most of the patients. Fractures and ectopic calcification did not happen after the operation. ② Postoperative blood bio-chemistry and frontal CT value：significant reductions in serum calcium （ P〈0. 01 ） , phosphorus （ P〈0. 01 ） and iPTH （P〈0. 01） levels occurred after surgery, compared with preoperative values. Six months after surgery frontal CT value increased than those in preoperative period （ P〈0. 05 ） .③ Postoperative complications and recurrence：postoperative hypocalcemia was frequently seen in 23 cases （76. 7%） and it could be effectively controlled by post-operative calcium administration. Temporary injury of recurrent laryngeal nerve was found in 2 patients who recov-ered 3 months after operation. Follow-up of six months, no patients relapsed after surgery. Conclusion PTX＋AT for SHPT in ESRD patients can ameliorate bone metabolism, and enhance bone mass and reduce the incidence of fractures. In conclusion, PTX＋AT is safe, economical and effective in the treatment for renal refractory secondary hyperthyroidism.