微波消融治疗原发性甲状旁腺功能亢进的初步临床探讨

Microwave ablation in treatment of primary hyperparathyroidism:a preliminary clinical study

目的：探讨微波消融治疗原发性甲状旁腺功能亢进（ PHPT）的安全性与疗效。方法回顾性地分析6例患者共6个PHPT结节微波消融资料。消融功率25～30 W，多点消融，术后超声造影评估疗效。术后检测患者全段甲状旁腺素（iPTH）、血钙及血磷的变化。结果单枚腺体消融时间为550～840（638±138） s。术后1 d iPTH和血钙测值分别由术前（479.2±477.3）ng／L降为（69.3±49.8）ng／L（P＞0．05），（2.57±0.13）mmol／L降为（2.08±0.15）mmol／L（P＜0．05）。随访终点iPTH和血钙测值均略有上升（P＞0．05）。术后血磷测值无明显变化。术中及随访时间内未出现并发症。结论微波消融治疗PHPT是一种安全、有效的方法，可以明显降低iPTH和血钙测值，该技术可望成为手术治疗的替代手段。

Objective To investigate the safety and efficacy of microwave ablation （ MWA） in the treatment of primary hyperpara-thyroidism （ PHPT） .Methods Clinical data of 6 patients with totally 6 PHPT nodules managed by MWA in our center from August 2014 to July 2015 were collected and retrospectively analyzed .They underwent multiple point ablation therapy at a power of 25-30 W. After MWA, ultrasound examination was used to evaluate the efficacy of the ablation .The changes in intact parathyroid hormone （ iPTH） , and serum levels of calcium and phosphorus before and after the operation were detected and analyzed .Results The ablation time of one PHPT nodule was 550 -840 （638 ±138） s.In 1 d after MWA, the level of iPTH was decreased from （479.2 ±477.3）ng/L preoperatively to （69.3 ±49.8）ng/L （P〉0.05）, while that of calcium was declined from （2.57 ±0.13）mmol/L to （2.08 ±0.15）mmol/L （P〈0.05）.Their levels were slightly increased at the end of follow-up （P〉0.05）.There was no obvious change in the serum level of phosphorus before and after MWA （P 〉0.05）.No complication was found during and after MWA treatment.Conclusion MWA is safe and effective in the treatment of PHPT , and can obviously decrease the levels of iPTH and serum calcium.It might become an alternative for surgical treatment in the management of PHPT .