继发性甲状旁腺功能亢进手术治疗对甲状旁腺激素、血清钙磷水平和睡眠质量的影响

Impact of secondary hyperparathyroidism surgery on PTH,serum calcium,serum phosphorus level and sleep quality

目的探讨继发性甲状旁腺功能亢进(SHPT)外科手术治疗对甲状旁腺激素(PTH)、血清钙磷水平和睡眠质量的影响,评价此治疗方法的有效性和安全性。方法回顾性分析2011年3月-2014年11月绵阳市第三人民医院收治的40例SHPT行甲状旁腺全切除+自体移植术治疗的患者的临床资料,女性19例,男性21例,年龄(46.3±13.2)岁,对比手术前后PTH、血清钙磷水平、匹兹堡睡眠质量指数量表(PSQI)评分并总结手术并发症等临床变化。结果 40例手术,其中37例各切除4枚甲状旁腺,1例切除5枚甲状旁腺,2例各切除3枚甲状旁腺。平均手术时间为(55.5±10.5)min。术后1例出现声音嘶哑,1例出现声音低沉,32例手术后第二天发生了手足麻木,给予对症治疗后均好转或恢复。术前PTH为(957.8±76.7)pmol/L,血清钙为(2.5±0.3)mmol/L,血清磷为(2.1±0.2)mmol/L,PSQI总评分(13.5±0.9)分。术后6个月随访发现所有患者PTH(112.6±21.2)pmol/L、血清钙(2.1±0.1)mmol/L、血清磷水平(1.3±0.2)mmol/L和PSQI总评分(7.2±0.8)分均较治疗前低(P均<0.05)。结论 SHPT的外科手术治疗可控制SHPT患者血清钙磷水平、改善睡眠质量。

Objective To investigate the impacts of surgical treatment for secondary hyperparathyroidism （ SHPT ） on parathyroid hormone （PTH） , serum calcium and phosphorus levels and sleep quality, meanwhile to evaluate the efficacy and safety of this treatment. Methods The clinical data of 40 patients with SHPT who underwent the total resection and autograft of parathyroidectomy from March 2011 to November 2014 were retrospectively analyzed. There were 19 females and 21 males and their mean age were （46. 3 ± 13.2） years old. The scores of PTH, serum calcium and phosphorus levels, Pittsburgh Sleep Quality Index （PSQI） were compared before and after operation. At the same time, the clinical changes of surgical complications were summarized. Results Among 40 cases of surgery, 37 cases removed 4 parathyroid, 1 case had resection of 5 parathyroid, and 2 cases had the removal of 3 parathyroid. The average operation time was （55. 5 ± 10. 5） min. 1 case had hoarseness, 1 case had hypoechoic, and 32 cases had numbness of hands and feet on the 2ndday after operation, all of them were improved or recovered after receiving symptomatic treatment. Before operation, the mean volume of PTH was （957. 8 ± 76. 7） pmol /L,serum calcium was （2. 5 ±0. 3） mmol /L, serum phosphorus was （2. 1 ± 0. 2） mmol/L and mean PSQI total score was （13.5 ±0. 9）. After 6 months follow - up, the average volume of PTH was （112.6 ±21.2） pmol /L,serum calcium was（2. 1 ±0. 1） mmol /L,serum phosphorus level was（ 1.3 ± 0. 2） mmol/L and average total PSQI score was（ 7. 2 ± 0. 8 ）,which were all lower than before operation（ P 〈 0. 05 ） . Conclusion Surgical treatment of SHPT can control serum calcium, phosphorus levels and improve sleep quality for SHPT patients.