血液透析继发性甲状旁腺功能亢进患者行甲状旁腺全切术+自体前臂移植术的疗效观察

Curative effect of total parathyroidectomy and autogenous transplantation in patients with secondary hyperparathyroidism of hemodialysis

目的观察血液透析继发性甲状旁腺功能亢进(SHPT)患者行甲状旁腺全切术(tPTX)+自体前臂移植术(AT)的效果及对甲状旁腺功能恢复的影响。方法收集2014年6月—2016年5月复旦大学附属中山医院青浦分院普外科接受tPTX+AT治疗的52例血液透析SHPT患者的临床资料,观察患者症状缓解情况,并以自身对照的形式,监测患者手术前后全段甲状旁腺激素(iPTH)、血钙、血磷、钙磷乘积、碱性磷酸酶(ALP)等实验室指标的变化,统计并发症、复发情况,评价患者生活质量改善情况。结果 (1)52例SHPT患者手术成功率为98.08%(51/52),术后6个月患者皮肤瘙痒、骨关节疼痛、不宁腿综合征所占比例明显低于术前,但仅皮肤瘙痒、骨关节疼痛对比差异有统计学意义(X^2=13.565、57.671,P<0.01)。(2)与术前比较,术后1周、1个月,6个月、12个月患者iPTH、血磷、钙磷乘积明显降低(F=12.141、6.471、8.458,P<0.01);术后1周、1个月患者血钙呈一过性降低(t=7.887、5.928,P<0.05),术后6,12个月均恢复至术前水平;术后1个月、6个月、12个月患者ALP水平均降低,但仅术后6、12个月与术前比较差异有统计学意义(t=3.386、5.564,P<0.01);(3)术后3个月、6个月、12个月患者KDTA评分均上升,与术前比较差异有统计学意义(t=10.581、12.138、9.845,P<0.01);(4)52例患者中术后出现一过性声音嘶哑3例(5.77%),术后1个月内发生低钙血症39例(75.00%),随访12个月复发2例(3.85%)。结论血液透析SHPT患者采用tPTX+AT治疗安全有效,可改善甲状旁腺功能亢进,提升患者生活质量。

Objective To observe the effects of total parathyroidectomy(tPTX) and autologous transplantation(AT)in the treatment of secondary hyperparathyroidism(SHPT) of hemodialysis and the effect on the recovery of parathyroid function. Methods The clinical data of 52 patients with SHPT of hemodialysis who were treated with PTX and AT in our hospital from June 2014 to May 2016 were collected, and the relief of symptoms was observed. Changes of laboratory parameters such as intact parathyroid hormone(iPTH), blood calcium, serum phosphorus, calcium phosphorus product and alkaline phosphatase(ALP) were monitored. Complications and recurrence were statistically analyzed, and the improvement of quality of life was determined. Results(1)The success rate of surgery in 52 patients with SHPT was 98.08%(51/52). 6 months after surgery, the proportions of patients with itchy skin, joint pain and restless leg syndrome were significantly lower than those before surgery, but there were statistically significant differences only in itchy skin, bone and joint pain(X^2 = 13. 565,X^2=57.671, P <0.01).(2) 1 week, 1 month, 6 months and 12 months after surgery, iPTH, serum phosphorus and calcium phosphorus product decreased significantly( F =12.141, F =6.471, F =8.458, P <0.01). The serum calcium showed a transient decrease at 1 week and 1 month after surgery( P <0.05), and recovered to the level before surgery at 6 months and12 months after surgery. 1 month, 6 months and 12 months after surgery, ALP levels decreased, but there were significant differences only after 6 and 12 months after surgery, compared with those before surgery( F =5. 788, P <0. 05).(3)Among the 52 patients, there were 3 cases(5.77%) with transient hoarseness after surgery and 39 cases(75.00%) with hypocalcemia within 1 month after surgery, and there were 2 cases(3.85%) of recurrence during 12 months of follow-up.(4)3 months,6 months and 12 months after surgery, KDTA scores increased( t = 10. 581, t =12. 138, t =9. 845, P <0. 01).Conclusion PTX combined with AT is safe and effective in the treatment of SHPT of hemodialysis. The combined treatment can relieve hyperparathyroidism, and improve the quality of life of patients.