尿毒症患者继发性甲状旁腺增生结节微波消融治疗的临床观察

Clinical Observation of Microwave Ablation for Secondary Parathyr oid Hyperplasia in the Patients with Uremia

目的观察微波消融治疗尿毒症患者继发性甲状旁腺功能亢进(Secondry hyperparathyroidism,SHPT)的临床疗效。方法选取4例尿毒症合并继发甲旁亢患者,施行超声引导下甲状旁腺增生结节微波消融治疗,分别于消融前,消融后1 d,1个月及6个月检测患者血清全段甲状旁腺激素(iPTH),血钙,血磷,碱性磷酸酶(ALP)及临床症状(包括乏力、骨痛、皮肤瘙痒、失眠、不安腿、活动受限等),并进行比较。结果 4例患者均成功实施了消融手术,一共16个结节,成功消融15个。与消融术前比较,患者术后1 d,1个月及6个月的血钙、血磷及iP TH均有显著改善,骨痛、皮肤瘙痒等症状也有明显缓解。两例患者消融术后均出现呛咳及声嘶症状,一周后自行缓解。结论微波消融治疗尿毒症患者继发性甲状旁腺功能亢进,能明显改善患者iP TH,钙磷代谢水平及临床症状,术中并发症少,是一种安全有效的新型治疗方式。

Objective To observe the clinical effectiveness of microwave ablation in the treatment of secondary hyperparathyroidism（SHPT）in patients with uremia. Methods Four cases of uremic patients with SHPT were treated with ultrasound-guided percutaneous microwave ablation（MWA）. Levels of intact parathyroid hormone（iPTH）,serum calcium,phosphorus,and alkaline phosphatase（ALP）were compared before and after 1 day,1 month and 6 months. Results Four patients were successfully ablated for 15 nodules（a total of16 nodules）. Serum iP TH,calcium and ALP after ablation were statistically significantly lower than that of before. Bone pain,skin itching and other symptoms were significantly improved. Two patients had a cough and hoarseness after ablation,and relieved on one week after MWA. Conclusion Ultrasound-guided percutaneous MWA is safe and effective in destroying parathyroid gland tissue in uremia patients with severe SPHT. It can significantly improve patients with the levels of iP TH,calcium and phosphorus,and their clinical symptoms without obvious complications. It is a safe and effective new treatment.