甲状旁腺全切术对继发性甲状旁腺功能亢进的治疗效果

Therapeutic effect of parathyroidectomyon secondary hyperparathyroidism

目的观察甲状旁腺全切除术对继发性甲状旁腺功能亢进的治疗效果。方法选择因尿毒症引起的继发性甲状旁腺功能亢进就诊于娄底市中心医院耳鼻咽喉头颈外科且长期行血液透析治疗患者14例。对患者手术前后血液中全段甲状旁腺激素(parathyroid hormone,PTH)、血清钙值、临床症状、术后并发症、死亡率和复发情况进行回顾性分析,结合相关文献进行总结讨论。结果 14例患者术后无一例死亡,未见明显声嘶及术后切口出血,所有患者均伴有低钙血症,术后四肢麻木,血清钙术后1周内下降明显,给予对症支持治疗,1周后逐渐回升至正常水平。术后复查PTH明显降低。患者术后骨痛及皮肤瘙痒症状全部得到缓解,肌无力、纳差症状得到明显改善,全身营养状况好转。结论甲状旁腺全切除术治疗终末期肾病所致的继发性甲旁腺功能亢进是一种安全、有效的方法。

Objective To investigate the therapeutic effect of parathyroidectomy on secondary byperparathyroidism. Methods 14patients with refractory hyperparathyroidism secondary to renal failure underwent parathyroidectomy in our department. Their data including clinical symptoms, serum levels of parathyroid hormone （PTH） and calcium before and after operation, postoperative complications, mortality and recurrence were recorded andanalyzed retrospectively combined with literature review. Results Parathyroidectomy was successfully performed in all the 14 patients. As for the postoperative complications, no patient died, and no obvious hoarsenessor incisional bleeding occurred. Postoperative hypocalcemia was present in all patients with numbness of limbs and the serum level of calcium went back to normal in one week. Postoperative serum level of PTH was significantly lower than that before operation （P 〈 0.01 ）. Theirsymptoms of bone pain and pruritus got relieved,myasthenia, inappetence and nutritional status got improved. Conclusion Parathyroidectomy was effective and safe for the management of refractory hyperparathyroidism secondary to end-stage renal disease.