甲状旁腺全切术治疗尿毒症继发性甲状旁腺功能亢进的临床观察

Clinical Observation on the Treatment of Secondary Hyperparathyroidism in Uremic Patients Treated with Total Parathyroidectomy

目的探讨甲状旁腺全切术治疗尿毒症继发性甲状旁腺功能亢进的临床疗效。方法回顾性分析2007年4月—2015年1月29例尿毒症继发性甲状旁腺功能亢进行甲状旁腺全切术的临床资料。收集患者术前、术后甲状旁腺素和血清钙、磷、碱性磷酸酶结果,术后并发症及临床症状的缓解情况。结果有24例切除了4枚甲状旁腺腺体,3例切除3枚甲状旁腺腺体,2例切除2枚甲状旁腺腺体;术后1周、1个月、1年的甲状旁腺素、血钙、血磷较术前明显下降(P<0.05),碱性磷酸酶术后1月及1年较术前明显下降(P<0.05),血钙<1.8mmol/L 7例,但无低钙抽搐发生;骨痛、皮肤瘙痒、肌肉无力、睡眠障碍等临床症状均明显改善。结论甲状旁腺全切术是治疗尿毒症继发性甲状旁腺功能亢进的安全有效方法。

Objective To investigate the clinical effect of parathyroid total resection in the treatment of secondary hyperparathyroidism for uremia patients.Methods Clinical data of 29 cases with uremic secondary hyperparathyroidism and being treated with parathyroid resection from April 2007 to January 2015 were analyzed retrospectively.Parathyroid hormone,serum calcium,phosphorus,alkaline phosphatase before operation and after operation,postoperative complications and clinical symptoms of patients were collected.Results There were 24 cases who were resected four parathyroid glands and 3 cases were removed 3 parathyroid glands,2cases were resected 2 parathyroid glands.After operation 1 week,1 month and 1 year,parathyroid hormone,serum calcium,phosphorus in patients decreased significantly compared with those before operation（P〈0.05）,level of alkaline phosphatase at 1 month and 1 year after operation decreased significantly compared with that before operation（P〈0.05）.There were 7 cases whose blood calcium were below1.8mmol/L,but no low calcium convulsions.Clinical symptoms such as bone pain,itchy skin,muscle weakness,sleep disorders were significantly relieved.Conclusion Parathyroid total resection is a safe and effective method for the treatment of secondary hyperparathyroidism in uremic patients.