继发性甲状旁腺功能亢进症的再手术临床分析

Clinical analysis of reoperation for secondary hyperparathyroidism

目的探讨甲状旁腺切除术治疗继发性甲状旁腺功能亢进症（HPT）后复发再手术的安全性和效果。 方法选择2001年4月至2012年10月在中日友好医院普外科因继发性HPT行甲状旁腺切除术后出现持续性HPT或复发性HPT行再手术的患者10例。其中男性6例，女性4例。年龄（46.9±7.7）岁（范围：36～57岁）。持续性HPT 8例，复发性HPT 4例。收集患者一般情况、症状变化、手术时腺体切除和移植记录、病理学报告，以及术前、术后和随访全段甲状旁腺素（iPTH）、血清钙、磷、碱性磷酸酶结果，并分析手术失败原因。根据术后症状改善情况、iPTH结果、围手术期病死率和术后并发症发生情况判断疗效。 结果10例患者中8例进行了1次再手术（包括颈部探查术7例，前臂探查术1例），2例进行了2次再手术（均为颈部探查术）。无术后死亡病例。2例次术中发生喉返神经损伤，3个月后逐渐恢复，2年后复查声带运动恢复。10例次术后发生低钙血症，经补充钙剂治疗后获得有效控制。无气管、食管损伤及颈部血肿等并发症。6例接受1次再手术的患者、2例接受2次再手术的患者均有明显疗效。 结论对于终末期肾病所致的继发性HPT手术治疗后出现的持续性HPT或复发性HPT，再手术是一种安全和有效的治疗手段。

ObjectiveTo investigate the safety and efficacy for reoperation after parathyroidectomy for persistent and recurrent secondary hyperparathyroidism （HPT）. MethodsTotally 10 patients with persistent or recurrent HPT who underwent parathyroidectomy reoperation at Department of General Surgery, China-Japan Friendship Hospital from April 2001 to October 2012 were selected. Among them, 6 were male and 4 were female with age of （46.9±7.7） years （range： 36 to 57 years）. There were 8 cases of persistent HPT and 4 cases of recurrent HPT. The general health condition, symptom changes, gland excision and transplantation records, pathological reports and intact parathyroid hormone （iPTH）, serum calcium, phosphorus and alkaline phosphatase values of pre-operation, post-operation and during follow-up were collected and the causes of operation failure were analyzed. The efficacy was determined according to postoperative symptom improvement, iPTH values, perioperative mortality and postoperative complications. ResultsOf the 10 patients, 8 cases underwent reoperation once （including 7 cases of neck exploration, 1 case of forearm exploration）, and 2 cases underwent reoperation twice （all neck explorations）. No postoperative death was reported. The laryngeal nerve damage occurred in 2 cases during reoperation, and it was gradually recovered 3 months after surgery with the vocal cord movement recovery after 2 years. Hypocalcemia occurred in all 10 cases after operation, and was effectively controlled with calcium supplement treatment. No complications such as the trachea and esophagus damage, and the neck hematoma were observed. The significant efficacy was demonstrated in 6 patients received 1 reoperation and 2 patients with 2 reoperations. ConclusionReoperation is a safe and effective treatment for the persistent or recurrent secondary HPT caused by end-stage renal disease after surgery.