腔镜甲状旁腺切除术在甲状旁腺功能亢进中的应用

Clinical Application of Endoscopic Parathyroidectomy for the Treatment of Hyperparathyroidism

目的探讨腔镜甲状旁腺切除术（endoscopicparathyroidectomy，EPTX）在原发性甲状旁腺功能亢进（primaryhyperparathymidism，PH门）或继发性甲状旁腺功能亢进（secondaryhyperparathyroidism，SHPT）中的应用价值。方法回顾性分析2014年3月-2016年7月在航天中心医院进行EPTX治疗的PHPT和SHPT病例资料。结果共进行42例EPTX，包括8例PHPT和34例SHPT，无中转开放手术，手术时间82~210min，平均135．4min，术中出血量15．105mL，平均45．6mL，切除甲状旁腺数量1～6枚，平均3．8枚，术后引流量45~120mL，平均70．5mL，术后静脉补钙时间1～7d，平均4．2d，术后住院时间3～14d，平均4．6d，术后1d疼痛评分2～7分，平均4．3分。总并发症发生率为11．9％，无一例围手术期死亡。与术前比较，术后1d全段甲状旁腺素（intactparathyroidhormone，iPTH）、血钙、血磷显著降低（P〈0．01），碱性磷酸酶（Mkalinephosphatase，ALP）无显著变化（P〉0．05）。术后随访12～42月，平均20月，在全部42例中有2例复发（4．8％）。结论腔镜甲状旁腺切除术治疗甲状旁腺功能亢进安全可行，适合在有美容需求的患者中施行。

Objective To discuss the clinical application of endoscopic parathyroidectomy （EPTX） in the treatment of primary hyperparathyroidism （PHPT） and secondary hyperparathyroidism （SHPT）. Methods Clinical data of PHPT and SHPT patients underwent surgical treatment in Aerospace Central Hospital, between March 2014 and July 2016, were analyzed retrospectively. Results A total of 42 cases of EPTX were performed, including 8 cases of PHPT and 34 cases of SHPT, with no conversion to open surgery, and the average operating time was 135.4 min （82 - 210 min）, the average amount of intraoperative blood loss was 45.6 ml （15 - 105 ml）, the average number of dissected parathyroid gland was 3.8 （1 - 6）, the average amount of postoperative drainage was 70.5 m1（45 ~ 120 ml）, the average duration of intravenous calcium infusion was 4.2 days （1 ~ 7day）, the average postoperative hospital stay was 4.6 days （3 - 14day）, the average score of pain on the first day postoperatively was 4.3 （2 ~ 7）. Overall incidence of complication was 11.9% and no dead case occurred in perioperative period. The level of intact parathyroid hormone （iPTH）, calcium, phosphorus on the first day after surgery decreased significantly when compared with preoperative level （P 〈 0.01）, however, the change of alkaline phosphatase （ALP） level was not statistically significant （P〉 0.05）. The average follow-up time was 20 months （12 ~ 42 months）, and 2 recurrent cases （4.8%） was found. Conclusions EPTX is an effective and safe procedure in the treatment of hyperparathyroidism and is suitable for patients with cosmetic requirement.