达芬奇机器人甲状旁腺全切加部分腺体自体移植术治疗肾性甲状旁腺功能亢进

Use of da Vinci Si surgical system in total parathyroidectomy with autotransplantation for secondaryrenal hyperparathyroidism

目的探讨达芬奇机器人甲状旁腺全切加部分甲状旁腺自体移植术（totalparathyroideetomywithautotransplantation，tVTX＋AT）在慢性肾功能衰竭继发甲状旁腺功能亢进患者外科治疗中的安全性及有效性。方法回顾性分析2014年3月至2016年10月在济南军区总医院接受达芬奇机器人tPTX＋AT手术的16例肾性甲状旁腺功能亢进患者的临床资料。结果16例tPTX＋AT手术均顺利完成，无手术相关严重并发症，无中转开放手术，共切除62枚甲状旁腺。平均手术时间（136±24）min，术后临床症状改善明显，相关生化指标明显下降或改善，手术美容效果满意，随访6个月至2年血清全段甲状旁腺素、血钙、血磷及临床症状变化情况等，随访期间无复发病例。结论达芬奇机器人甲状旁腺全切加部分甲状旁腺自体移植术治疗肾性甲状旁腺功能亢进是安全、有效的。

Objective To evaluate the clinical safety and effectiveness of da Vinci Si surgical system in total parathyroidectomy with autotransplantation of secondary hyperparathyroidism. Methods A retrospective analysis was conducted with da Vinci Si surgical system on 16 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Mar 2014 to June 2016. The changes of clinical symptoms, parathyroid hormone, calcium and phosphate blood levels were followed up from 6 months to 2 years. Results Surgery was successful in all 16 cases and 62 parathyroid glands were resected. There were no operation-related complications and no conversions to open or endoscopic surgery. Mean operation time was （136 ±24 ） minutes. In all postoperative cases the musculoskeletal pain, skin itching were relieved or disappeared. PTH, calcium and phosphate blood levels decreased and no recurrence during follow-up period, The postoperative cosmetic result was satisfatory. Conclusions Da Vinci Si surgical system used in the ＇parathyroid surgery is safe and effective, especially suitable for patients with cosmetic requirements.