甲状旁腺切除术治疗透析患者继发性甲状旁腺功能亢进症相关指标的变化分析

Changes in relative indexes of secondary hyperparathyroidism in dialysis patients treated with parathyroidectomy

目的探讨甲状旁腺切除术治疗透析继发性甲状旁腺功能亢进症对相关指标的影响。方法选择确诊为继发性甲状旁腺功能亢进的患者82例,均行甲状旁腺切除术治疗,按照随机综合序贯法分为两组,分别采用甲状旁腺切除术(t PTX)和甲状旁腺全切除术加前臂自体移植术(t PTX+AT)进行治疗,比较两种手术方式术后相关指标变化情况。结果术后1月两组全段甲状旁腺激素、碱性磷酸酶水平均较术前降低(P<0.05),血清钙和血清磷与术前比较差异无统计学意义(P>0.05),两组间上述指标水平差异均无统计学意义(P>0.05);两组术后住院时间、术后并发症发生率比较差异均无统计学意义(P>0.05)。结论 t PTX单独应用与t PTX+AT治疗继发性甲状旁腺功能亢进症对患者血清钙和血清磷均无显著影响,且均可改善全段甲状旁腺激素、碱性磷酸酶水平水平,推荐单纯采用t PTX治疗。

To analyze the influence of parathyroidectomy on related indexes of secondary hyperparathyroidism caused by dialysis.Eighty-two patients with secondary hyperparathyroidism were selected and all patients were treated with parathyroidectomy.The patients were randomly divided into two groups which were treated with parathyroidectomy(tPTX)and total parathyroidectomy with forearm autotransplantation(tPTX+AT),respectively.The relative indexes of the two surgical procedures were compared.After 1 month of surgery,the levels of intact parathyroid hormone and alkaline phosphatase were significantly decreased when compared to before operation in both groups(P<0.05),while the levels of serum calcium and phosphorus were not significantly different from before operation(P>0.05),and there were no significant differences between the two groups(P>0.05).There were no significant differences in postoperative hospital stay and postoperative complication rates between the two groups(P>0.05).Parathyroidectomy alone or in combination with forearm autograft in treatment of secondary hyperparathyroidism has no significant effect on serum calcium and phosphorus,and can improve the levels of parathyroid hormone and alkaline phosphatase.Therefore,we recommend simple parathyroid resection for treatment of the disease.