传统手术与超声引导下射频消融术在SHPT治疗中的对比研究

Comparative Study of Traditional Surgery and Ultrasound-guided Radiofrequency Ablation in Treatment of SHPT

目的:比较超声引导下射频消融术(RFA)与甲状旁腺切除术(PTX)治疗继发性甲状旁腺功能亢进(SHPT)的临床疗效及并发症情况。方法:选取2014年3月-2017年3月本院收治的SHPT患者79例。按照不同治疗方式将其分为RFA组32例和PTX组47例。比较两组手术总时间、住院天数、并发症,手术前后临床症状评分、血肌酐(Scr)、全段甲状旁腺激素(iPTH)。结果:RFA组手术总时间、住院天数均短于PTX组,比较差异均有统计学意义(P<0.05);手术前后,两组骨关节痛、皮肤瘙痒、肌无力评分比较,差异均无统计学意义(P>0.05);术后1周,两组骨关节痛、皮肤瘙痒、肌无力评分均低于术前,比较差异均有统计学意义(P<0.05);RFA组并发症发生率为3.1%(1/32),低于PTX组的19.1%(9/47),但比较差异无统计学意义(P>0.05);两组手术前后及不同时间点的Scr水平比较,差异均无统计学意义(P>0.05);两组术后i PTH水平均低于术前(P<0.05),但两组间不同时间点比较差异均无统计学意义(P>0.05)。结论:超声引导下RFA治疗SHPT可以达到与手术治疗相似的临床疗效,而且RFA较PTX手术时间短、住院时间短、并发症少,是一种有效、安全的微创治疗方法。

Objective：To compare the clinical efficacy and complications of ultrasound-guided radiofrequency ablation（RFA） and parathyroidectomy（PTX） in treatment of secondary hyperparathyroidism（SHPT）.Method：A total of 79 patients with SHPT from March 2014 to March 2017 in our hospital were selected.According to different treatment methods,they were divided into RFA group（n=32） and PTX group（n=47）.The total operation time,hospital stay,complications,clinical symptom score,serum creatinine（Scr） and immunoreactive parathyroid hormone（i PTH） before and after operation between two groups were compared.Result：The total operation time and hospital stay in RFA group were shorter than those of PTX group,the differences were statistically significant（P〈0.05）.Before and after operation,the scores of osteoarthralgia,pruritus and myasthenia between two groups were compared,the differences were not statistically significant（P〈0.05）.After operation 1 week,the scores of osteoarthralgia,pruritus and myasthenia in two groups were all lower than those of before operation,the differences were statistically significant（P〈0.05）.The incidence of complications in RFA group was 3.1%（1/32）,was lower than 19.1%（9/47） in PTX group,but the difference was not statistically significant（P〈0.05）.The levels of Scr in two groups before and after operation and at different time points were compared,the differences were not statistically significant（P〈0.05）.The levels of i PTH after operation in two groups were lower than those of before operation（P〈0.05）,but the different time points in two groups were compared,the difference were not statistically significant（P〈0.05）.Conclusion：Ultrasoundguided RFA treatment of SHPT can achieve similar clinical efficacy to surgical treatment,and RFA has shorter operation time,shorter hospital stay and fewer complications than PTX,which is an effective and safe minimally invasive treatment.