尿毒症规律血液透析患者继发性及三发性甲状旁腺功能亢进症合并甲状腺癌三例报告

Three cases of thyroid carcinoma accompanied with secondary or tertiary hyperparathyroidism in uremia patients on maintenance hermodialysis

目的探讨尿毒症规律血液透析患者继发性及三发性甲状旁腺功能亢进并发甲状腺癌的临床特征、发病机制及治疗方法。方法回顾性分析天津市第三中心医院普外科2006—2015年收治的1例继发性甲状旁腺功能亢进伴甲状腺癌和2例三发性甲状旁腺功能亢进伴甲状腺癌患者的临床表现、检验检查结果、手术方式及术后治疗方法,并结合国内文献报道的相似病例探讨其发病机制及治疗方式。结果 3例均为长期透析患者,出现骨痛、皮肤瘙痒、乏力等症状,血磷、血钙失调,甲状旁腺素(PTH)升高,影像学检查及病理证实2例为甲状旁腺增生伴腺瘤形成,1例为甲状旁腺增生。患者均并发甲状腺乳头状癌,行甲状腺癌根治+甲状旁腺全切+自体移植治疗,术后患者恢复良好。结论尿毒症患者继发性或三发性甲状腺功能亢进可能会增加甲状腺癌的发病风险,手术治疗效果确切。

Objective To investigate the clinical features,pathogenesis and therapeutic method of uremiahemodialysis in patient with secondary or tertiary hyperparathyroidism accompanied by thyroid carcinoma.Methods Theclinical data of2cases of tertiary hyperparathyroidism with thyroid carcinoma and1case of secondary hyperparathyroidismwith thyroid carcinoma were retrospectively collected and analyzed from department of general surgery of Tianjin ThirdCentral Hospital from2006to2015.The pathogenesis and therapeutic method were investigated with the review of relatedChinese literatures.Results Three patients all underwent the long-term hemodialysis and presented with bone pain,itchyskin,fatigue and other symptoms.Clinic examination revealed that serum phosphate and serum calcium were disordered.The imaging and pathological examination proved that2cases were parathyroid hyperplasia with adenoma formation and1case was only parathyroid hyperplasia.All the patients were accompanied by thyroid cancer,which treated with radicaloperation of thyroid cancer and parathyroid gland and autotransplantation.The patients recoved well after operation.Conclusion Uremia patients with secondary or tertiary hyperparathyroidism may have a higher morbidity of thyroid cancer,and surgical treatment will achieve an ideal outcome.