甲状旁腺全切除治疗继发性甲状旁腺功能亢进

Total parathyroidectomy in the treatment of secondary hyperparathyroidism

目的:分析甲状旁腺全切除术(TPTX)治疗继发性甲状旁腺功能亢进症(SHPT)的疗效和安全性。方法:回顾分析2012年7月~2015年12月在中日友好医院行TPTX的135例SHPT患者临床资料。收集患者术前、术后以及随访的血全段甲状旁腺素(iPTH)和生化(血清钙、磷和碱性磷酸酶)结果。记录术前临床症状、术后症状缓解情况、术后并发症和复发情况。结果:135例患者均成功完成手术,手术时间30~95min,平均56min。7例患者在术中发现甲状腺癌同时行甲状腺癌根治术,5例患者术中行甲状腺肿物切除术。术后因不明原因的感染中毒性休克死亡1例。无喉返神经损伤病例。术后低钙血症发生率77%(104/135),经积极静脉、口服补钙或高钙液透析后均获有效控制。术前有骨痛、瘙痒及入睡困难的患者术后症状均有不同程度的缓解。与术前比较,患者术后血iPTH、血磷、血钙及钙磷乘积水平均显著降低(均P<0.01),碱性磷酸酶(ALP)与术前相比无显著性差异(P>0.05)。随访7~55个月,平均20个月,仅1例术后12个月复发,术后18个月行二次手术后好转,余无复发。结论:TPTX治疗SHPT安全有效,手术时间短、创伤小,术后复发率低且无严重并发症。

Objective：To analyze the efficacy and safety of total parathyroidectomy （TPTX）in the patients with secondary hyperparathyroidism （SHPT）.Methods：The clinical data of 135 cases of SHPT treated with TPTX from July 2012 to December 2015 were analyzed retrospectively.The results of serum intact parathyroid hor- mone （iPTH）and biochemistry tests （serum total calcium,phosphorus and alkaline phosphatase） were collected preoperatively and postoperatively.The postoperative symptoms,complications and recurrence were investigated as wall.Results：All of 135 patients＇ surgery were performed successfully and the mean operating time was 56 minutes（from 30 to 95 minutes）.Seven cases of thyroid cancer and 5 cases of benign nodules were diagnosed during surgery,radical or thyroid nodule resection were performed at the same time.One patient died of toxic shock after surgery.None recurrent laryngeal nerve was injured.Postoperative hypocalcemia was frequently seen in 104 cases（77%）,and all were effectively controlled by calcium administration or high calcium dialysis.After operation,bone pain,itching and insomnia were alleviated and improved in all cases.The postoperative levels of serum iPTH,calcium,phosphorus and calcium xphosphorus were decreased significantly when compared with that before surgery （all P〈0.01）,but there was no statistical significance in the levels of alkaline phosphatase compared with preoperative levels （P〉0.05）.The mean follow-up time was 20 months （from 7 to 55 months）, and there was only 1 case （0.74%）recurrence in the 135 cases,and this case were relieved after second surgery.Conclusion：TPT3（ is an effective and safe way in the treatment for those patients with SHPT.It has short operation time ,less trauma,low recurrence rate and no severe complications.