甲状旁腺全切除自体前臂移植术治疗肾功能不全继发性甲状旁腺功能亢进

Efficacy of total parathyoidectomy with forearm autograft for hyperparathyroidism secondary to chronic renal failure

目的:研究甲状旁腺全切除(PTX)自体前臂移植术治疗慢性肾功能衰竭继发性甲状旁腺功能亢进(SHPT)的疗效和安全性。方法:回顾性分析2011年12月—2015年12月接受PTX自体前臂移植的30例慢性肾功能衰竭终末期并SHPT患者的临床资料,观察患者术后临床症状改善情况、血清全段甲状旁腺激素(iPTH)、钙、磷及钙磷乘积的变化,以及术后并发症与复发情况。结果:所有患者均手术成功。术后患者临床症状均明显改善;血清iPTH、钙、磷及钙磷乘积水平均较术前明显降低(均P<0.05)。12例患者出现一过性喉返神经损伤,均自行好转。术后8例(2.7%)复发,7例再次手术后症状缓解。结论:PTX自体前臂移植术是治疗慢性肾功能衰竭SHPT的一种安全有效的方法。

Objective： To assess the efficacy and safety of total parathyroidectomy（PTX） with forearm autograft for secondary hyperparathyroidism（SHPT） due to chronic renal failure. Methods： The clinical data of 30 patients witThend-stage chronic renal failure and SHPT undergoing PTX with forearm autograft from December 2011 to December 2015 were retrospectively analyzed. Of the patients, the improvements of clinical symptoms and changes in serum level of intact parathyroid hormone（iPTH）, calcium, phosphorus and calcium-phosphorus product after surgery as well as the postoperative complications and recurrence were analyzed.Results： Operation was performed successfully in all patients. After operation, the clinical symptoms of these patients were all remarkably improved, their serum levels of iPTH, calcium, phosphorus and calciumphosphorus product were all significantly decreased compared with preoperative values（all P〈0.05）.Transient recurrent laryngeal nerve injuries occurred in 12 patients, and all recovered without treatment. Postoperative recurrence occurred in 8 patients（2.7%） and 7 of them underwent repeat operation, after which the symptoms were improved.Conclusion： PTX with forearm autograft is a safe and effective treatment for SHPT caused by chronic renal failure.